魏新朋，韩际奥，高　晓，杨　丽，马英杰

肝硬化患者病情与小肠细菌过度生长变化关系探讨

魏新朋，韩际奥，高晓，杨丽，马英杰

目的探讨小肠细菌过度生长（SIBO）与肝硬化病情严重程度的关系及小肠细菌生长与降钙素原、胆红素、血浆白蛋白、球蛋白的相关性。方法纳入本科收治的47例肝硬化患者和15名健康志愿者。受试者接受乳果糖氢呼气试验(LHBT)，检测小肠细菌过度生长情况使用全自动生化分析仪测定生化指标。采用自评表形式对肝硬化组患者症状进行评估。结果在15名健康志愿者中检出1例（6.6%）伴小肠细菌过度生长，而在47例肝硬化患者中检出22例（46.8%）患者伴小肠细菌过度生长，显著高于正常人（P＜0.01）；肝硬化患者LHBT集值为（157.81±98.32）ppm，显著高于健康人[(38.87±16.05)ppm,P＜0.01],血清胆红素为（93.31±55.15）μmol/L，显著高于健康人[（14.78±8.12）μmol/L,P＜0.01],白蛋白为（31.74±10.37）g/L，显著低于健康人[(43.90±7.63)g/L, P＜0.01]，球蛋白为（39.09±5.07）g/L，高于健康人[(35.94±2.31)g/L,P＞0.05],降钙素原为（0.10±0.07）ng/m l,显著高于健康人[(0.03±0.01)ng/ml,P＜0.01]；降钙素原、胆红素、血浆白蛋白、球蛋白与LHBT集值具有相关性（r=0.895、P＜0.005，r=0.907、P＜0.005,r=-0.810、P＜0.005,r=0.755，P＜0.005）。结论肝硬化患者SIBO发生率随肝功能损害程度的加重而增加，肝硬化SIBO患者腹胀及食欲不振更明显。降钙素原、胆红素和球蛋白分别与SIBO呈正相关，血浆白蛋白与SIBO呈负相关。

肝硬化；小肠细菌过度生长；氢呼气集值；胃肠道症状评估

【Abstract】Obiective To determine the prevalence of small intestinal bacterial overgrowth(SIBO)in cirrhotic patients,and its correlation to severity of cirrhosis.Methods 47 patients with cirrhosis were selected as observation group,and 15 healthy volunteers were selected as control group.The gastrointestinal symptom of patients were evaluated by a guidance for clinical rational.The data were statistical analysis using SPSS17.0. Results In 47 patients with liver cirrhosis,22 patients(46.8%)were SIBO positive.While in 15 healthy persons in control group,only 1 case(6.6%,P<0.01)was SIBO positive;the LHBT level in patients with cirrhosis was (157.81±98.32)ppm,significantly higher than in the control group[(38.87±16.05)ppm,P＜0.01],serum bilirubin levels were(93.31±55.15)μmol/L,significantly higher than that in the control group[(14.78±8.12)μmol/L,P＜0.01],plasma albumin were(31.74±10.37)g/L,significantly lower than that in the control group[(43.90±7.63)g/L,P＜0.01],globulin were(39.09±5.07)g/L,higher than that in the control group[(35.94±2.31)g/L,P＞0.05],procalcitonin were(0.10±0.07) ng/ml,significantly higher than that in the control group[(0.03±0.01)ng/m l,P＜0.01];plasma procalcitonin，bilirubin，globulin and albumin were respectively correlated to SIBO（r=0.895,P＜0.005;r=0.907,P＜0.005;r=0.755,P＜0.005; r=-0.810,P＜0.005）.Conclusions SIBO was prevalent in patients with liver cirrhosis.The cirrhotic patients with SIBO were more easily bloating and Loss of appetite.

【Keywords】Liver cirrhosis;Small intestinal bacteria overgrowth;Hydrogen breath set-value;gastrointestinal symptom rating scale.

肝硬化患者由于肠道运动异常、胃肠道淤血、胃酸相对缺乏等因素，导致结肠的细菌移至空肠和十二指肠，可引起小肠细菌过度生长（Small intestinal bacterial overgrowth,SIBO）,继而增加内源性感染和内毒素血症的机会，从而加重了肝脏的损害，并可产生一系列并发症[1,2]。……