肠易激综合征患者症状与乳果糖呼气试验中产生的氢气和甲烷相关性研究

发布时间：2018-04-10 18:24

本文选题：肠易激综合征 + 乳果糖呼气试验　；参考：《天津医科大学》2014年硕士论文

【摘要】：背景：肠易激综合征(irritable bowel syndrome, IBS)是一种全球性常见的慢性消化系统疾病,其特点为腹部不适或腹痛伴排便习惯和(或)大便性状改变为特征的功能性肠病,腹部症状与排便习惯改变有明确的相关性,症状可持续存在或间歇发作。IBS的病因尚不十分清楚,目前认为是由多种因素共同作用引起,近年来研究认为肠道细菌过度生长(small intestinal bacteria overgrowth, SIBO)可能在发病机制中占有重要地位,并且广泛参与了IBS的病理生理过程,研究结果表明IBS患者普遍存在SIBO。乳果糖呼气试验(The lactulose breath test, LBT)是使用不被人体肠道吸收的乳果糖作为底物,肠道细菌能够分解发酵乳果糖产生气体,通过仪器定性或定量检测肠道中细菌产生的气体,是目前检测SIBO的重要手段。存在SIBO的患者在LBT时会产生氢气和甲烷,而IBS患者普遍存在气体相关症状如腹胀、胃胀、腹痛等,气体的产生及气体体积的大小可能是导致上述症状的重要原因。目的：本研究旨在通过测量IBS患者乳果糖呼气试验中氢气和甲烷的产生,收集患者胃肠道相关症状的严重程度评分,比较乳果糖呼气试验的阳性结果以及产生的气体与IBS患者症状的相互关系。研究对象与方法：选择2013年6月到2014年4月到本院消化内科门诊及住院治疗、符合罗马Ⅲ诊断标准的IBS患者43例,来自本院身体健康的职工16例。所有受试者均接受乳果糖呼气试验,IBS患者填写症状视觉模拟评分表。LBT阳性被定义为氢气浓度基础值大于20ppm,或在90分钟内上升达到20ppm；甲烷浓度基础值大于10ppm,或在90分钟内上升达到10ppm。通过计算产生的氢气或甲烷浓度曲线下面积获得气体体积。比较IBS患者和对照组LBT阳性率,比较IBS各亚型LBT阳性率及症状评分。根据呼气结果将IBS患者分为LBT(H2)阳性组、禁食后LBT(H2)阳性组、LBT(CH4)阳性组和LBT阴性组,分别记录患者的症状评分,SIBO阳性率,呼气所有浓度值和气体产生量。通过对IBS患者各组和对照组阳性率、呼气氢浓度值和气体产生量比较,进一步证实在LBT试验中气体的产生和IBS症状之间的关系。结果：1.IBS患者的LBT阳性率高于健康对照组(P=0.009),女性IBS患者的LBT阳性率要高于男性患者(P=0.017), IBS各亚组之间的LBT阳性率无明显差别,IBS-D患者LBT结果主要为H2阳性(66.7%),IBS-C患者LBT结果主要为CH4阳性(38.5%),LBTCH4)阳性受试者的年龄要大于LBT阴性结果的受试者(p0.01)；2.LBT阳性IBS患者氢气体积大于LBT阴性的IBS患者(P0.001)和LBT阳性的对照组受试者氢气体积(P=0.024),IBS-C患者所产生的甲烷体积大于IBS-D患者(P=0.045), LBT阳性受试者的平均气体体积大于LBT阴性的受试者(P=0.02);3. LBT阳性的IBS患者胀气(P=0.02)、腹胀(P=0.02)和便秘(P=0.01)症状评分均高于LBT阴性的患者,LBT(H2)阳性患者的腹胀(P=0.009)和胀气症状评分(P=0.036)均高于LBT(H2)阴性的患者,而LBT(CH4)阳性患者的便秘症状评分高于LBT(CH4)阴性的患者(P=0.002),禁食后LBT(H2)阳性患者的腹痛(P=0.04)、腹胀(P=0.03)和胀气(P=0.001)症状评分高于非禁食后LBT(H2)阳性的患者；4.气体总体积与腹胀(r=0.323,P=0.035)、腹痛(r=0.447,P0.001)和便秘(r=0.326,P=0.033)症状存在相关性。结论：IBS患者中SIBO有较高的发生率,IBS发病与SIBO有一定相关性；LBT时产生的H2与CH4与IBS患者的具体症状有关；通过计算H2与CH4浓度曲线下面积得到的气体体积与IBS患者的症状严重程度也存在相关性。我们的实验结果表明,LBT时产生的H2和CH4可用于预测IBS患者的相关症状。
[Abstract]:Background: irritable bowel syndrome (irritable bowel, syndrome, IBS) is a global common chronic digestive system diseases, characterized by abdominal pain or discomfort associated with defecation habits and (or) the change of character of stool functional bowel disorder characterized by abdominal symptoms and altered bowel habits have a clear correlation, etiology and symptoms of sustainable the presence or intermittent episodes of.IBS is still not very clear, it is caused by several factors, recent studies suggest that intestinal bacterial overgrowth (small intestinal bacteria overgrowth, SIBO) may play an important role in the pathogenesis, and widely involved in the pathophysiological process of IBS, the results show that IBS is prevalent in patients with SIBO. lactulose breath test (The lactulose breath test, LBT) is the use of lactulose is not human intestinal absorption of intestinal bacteria can be decomposed as substrate fermentation Lactulose to produce gas and gas produced by bacterial instrument qualitative or quantitative detection in the intestinal tract, is an important means of detecting SIBO. SIBO patients will produce hydrogen and methane in LBT, while IBS is prevalent in patients with gas related symptoms such as abdominal distension, abdominal pain, bloating, gas production and gas volume size may be is an important cause of these symptoms.
Objective: the aim of this study was to measure the occurrence of hydrogen and methane in lactulose breath test in patients with IBS, and to collect the score of the severity of gastrointestinal symptoms, and to compare the positive results of lactulose breath test and the relationship between the gas produced and the symptoms of IBS patients.
The research object and methods: from June 2013 to April 2014 to treatment in our hospital and hospital, 43 IBS patients met the diagnostic criteria of Rome cases, from 16 cases in our hospital health workers. All subjects underwent lactulose breath test in patients with IBS symptoms in visual analogue scale.LBT was defined as positive the basic value of hydrogen concentration is greater than 20ppm, or up to 20ppm in 90 minutes; the basis of methane concentration was greater than 10ppm, or up to 10ppm. by calculating hydrogen or methane concentration area under the curve of gas volume in 90 minutes. Comparison between IBS patients and control group of LBT positive rate, IBS positive rate of subtype LBT according to the results of breath and symptom score. IBS patients were divided into LBT positive group (H2), fasting LBT (H2) positive group, LBT (CH4) positive group and LBT negative group, the patients were recorded the symptom score, SIBO positive The rates of breath, all the concentration and gas generation were compared. The relationship between gas production and IBS symptoms in LBT test was further confirmed by comparing the positive rate of each group and the control group, the breath hydrogen concentration and the gas generation volume of IBS patients.
Results: the positive rate of LBT in 1.IBS patients was higher than control group (P=0.009), the positive rate of LBT in female IBS patients than in male patients (P=0.017), there was no significant difference between the IBS LBT positive rate between each subgroup of IBS-D patients, LBT results were positive for H2 (66.7%), IBS-C in patients with LBT CH4 positive results (38.5%), LBTCH4) positive subjects older than LBT negative subjects (P0.01); 2.LBT IBS with positive hydrogen volume greater than LBT negative IBS patients (P0.001) and LBT positive subjects in the control group (P=0.024), hydrogen volume volume of methane produced by IBS-C were greater than IBS-D patients (P=0.045), the average LBT positive subjects were larger than LBT negative subjects (P=0.02); flatulence 3. LBT positive patients with IBS (P=0.02) (P=0.02), abdominal distension and constipation symptom score (P=0.01) were higher in LBT negative patients, LBT (H2) positive patients (abdominal distension P=0.0 09) and bloating symptom score (P=0.036) was higher than that of LBT (H2) negative patients, and LBT (CH4) patients with positive symptoms of constipation score higher than LBT (CH4) negative patients (P=0.002), fasting LBT (H2) positive patients with abdominal pain, abdominal distension (P=0.04) (P=0.03) and gas (P=0.001) symptom score higher than non fasting LBT (H2) positive patients; 4. of the total volume of gas and bloating, abdominal pain (r=0.323, P=0.035) (r=0.447, P0.001) (r=0.326, P=0.033) and constipation associated symptoms.
Conclusion: the occurrence rate of SIBO was higher in patients with IBS, there is a certain correlation between the incidence of IBS and SIBO; LBT and CH4 produced by H2 and IBS in patients with specific symptoms; through the gas area calculation of H2 and CH4 concentration curve obtained under volume and IBS with the severity of clinical symptoms are related. Our experimental results show that LBT produced H2 and CH4 can be used to predict the related symptoms in patients with IBS.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R574.4

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