氢-甲烷气呼气试验在克罗恩病缓解期患者中的监测及意义研究

目的 分析缓解期克罗恩病(Crohn's disease,CD)患者小肠细菌过生长(small intestinal bacterial overgrowth,SIBO)的发生情况及其相关因素。探讨氢-甲烷气呼气试验在缓解期CD患者的临床应用价值。 方法 对25例缓解期CD患者(CDAI<150分)和20例健康人(对照组)进行以葡萄糖为底物的氢-甲烷气呼气试验,根据试验结果进一步将CD患者分为SIBO阳性组和SIBO阴性组。比较各组间症状(腹痛、腹胀)评分、大便性状、血清学炎症指标(TNF-α、IFN-γ、IL-6、IL-10)和氧化应激相关指标(GSH、LPO)水平差异,进行统计分析。 结果 ①CD组SIBO阳性率(44%)显著高于对照组(5%),差异具有统计学意义(χ2=0.72,P<0.01);②SIBO阳性组的腹胀评分高于SIBO阴性组(P<0.05),而对于腹痛评分、大便次数及性状2组间差异无统计学意义(P>0.05),但均高于健康对照组(P<0.01)。未发现年龄、病程、病变部位(L)、疾病行为(B)和CDAI评分与SIBO的发生相关。③CD患者中SIBO阳性组TNF-α水平高于SIBO阴性组(P<0.05),GSH水平低于SIBO阴性组(P<0.05),而2组间IFN-γ、IL-6、IL-10和LPO水平差异无统计学意义(P>0.05)。 结论 CD患者较健康人群更容易发生SIBO,且SIBO可能是加重患者消化系症状的原因之一,尤其表现为腹胀。究其机制而言,SIBO可通过氧化应激等途径导致炎症加重或持续,进一步使得疾病呈慢性化及反复发作过程。 

Detection and significance of hydrogen-methane breath test among Crohn disease patients in remission

Objective To analyze the small intestine bacterial overgrowth (SIBO) and related factors among Crohn disease (CD) patients in remission,and discuss the clinical application of hydrogen-methane breath test in CD patients. Methods The glucose hydrogen-methane breath tests was conducted among 25 CD patients in remission (CDAI<150) and 20 healthy people (control group).Based on testing result,CD patients in remission were further divided into SIBO positive and SIBO negative group.The symptom score (abdominal pain and abdominal distension),stool character,serum inflammatory markers (TNF-α,IFN-γ,IL-6 and IL-10) and oxidative stress related markers (GSH and LPO) among the three groups were compared statistically. Results ①The prevalence of SIBO (44%) among CD was significantly higher than that (5%) in control group (χ2=0.72,P<0.01).②Abdominal distension score among SIBO positive group was higher than that in SIBO negative group (P<0.05).There were no significant differences about abdominal pain score,stool frequency and character between the two groups (P>0.05),but significantly higher than that in the control group (P<0.01).Ages,course,location,behavior and CDAI scores were not correlated to SIBO.③GSH in SIBO positive group was lower than that in SIBO negative group (P<0.05).However,there were no significant differences about TNF-α,IFN-γ,IL-6,IL-10 and LPO between the two groups (P>0.05). Conclusions Compared with healthy people,the prevalence of SIBO is more common among CD patients,which may be one of reasons about the aggravation of digestive-related symptoms,especially abdominal distension.Intestinal microenvironment change and oxygen free radical removal may take part in the occurrence and development of SIBO.If patients are with positive SIBO,antibiotics and probiotics can be adopted.Because of the limited cases,more studies should be taken to identify the theory.