摘要
目的探讨核素显像联合乳果糖氢呼气试验对腹泻型肠易激综合征(IBS-D)患者小肠细菌过度生长(SIBO)的诊断与预后评价价值。方法 63例IBS-D患者纳入本次研究。禁食12 h后,测定基础氢呼气值,空腹口服试餐后,即刻记录氢呼气值,采集全腹静态图像,后每间隔15 min重复呼气与图像采集,至3 h结束。试验结束分别记录乳果糖氢呼气试验口盲转运时间(OL)、核素显像口盲转运时间(OR)及诊断OR时间相关性氢呼气值(HR)。参照Miller标准将63例IBS-D患者分为SIBO阳性组与阴性组。所有SIBO阳性患者与三分之一阴性患者接受利福昔明治疗,并记录治疗前后腹部症状罗马Ⅲ问卷评分差。结果 IBS-D患者中SIBO阳性率为46.03%,SIBO阳性组与SIBO阴性组性别、年龄、体重指数、婚姻状态、教育程度、家庭收入、职业、吸烟史、饮酒史、药物治疗史、焦虑、抑郁及应激性生活事件评估表(LES)评分比较,差异均无统计学意义(χ2=0.03,t=-0.85,U=432.00,χ2分别=3.82、0.04、0.00、0.11、1.14、0.01、0.01,t分别=0.98、1.11,U=492.00,P均>0.05)。OL为诊断IBS-D患者SIBO阳性的危险因素,OR为诊断SIBO阳性的保护因素(OR分别=0.91、1.11,P均<0.05)。OR、OL及HR值与预后评分无相关性(r分别=0.11、-0.19、0.26,P均>0.05)。OR受试者工作特征曲线下面积为0.66,最佳界值为67.50 min。结论核素显像联合乳果糖氢呼气试验对IBS-D患者SIBO有明确诊断价值,但尚不能用于预后评估。
Objective To investigate the clinical value of radionuclide imaging（RI）combined with lactulose hydrogen breath test（LHBT）for the diagnosis and therapeutic evaluation in diarrhea-predominant irritable bowel syndrome（IBS-D）patients with small intestinal bacterial overgrowth（SIBO）. Methods Sixty-three consecutive patients diagnosed as IBS-D were retrospectively analyzed. RI and LHBT was proceeded respectively per 15 min until 3 h. The oro-cecum transit time （OCTT）for LHBT（OL）,OCTT for RI（OR）and the temporal correlation of H2 level of OR（HR）were measured. Patients were divided into SIBO positive group and SIBO negative group based on the results of Miller ’s standard. IBS-D patients with positive SIBO entered a trial of oral rifaximin and their curative effects were recorded. Results According to the diagnostic criteria,the positive rate of SIBO in IBS-D patients was 46.03% . There were no significant differences in gender,age,body mass index,marital status,education level,family income,occupation,smoking history,drinking history,medication history,anxiety,depression and LES score between the SIBO positive group and the SIBO negative group（χ^2=0.03,t=-0.85,U =432.00,χ^2=3.82,0.04,0.00,0.11,1.14,0.01,0.01,t=0.98,1.11,U=492.00,P〉0.05）. The OL value was a risk factor for SIBO in IBS-D patients,while the OR value was a protective factor（OR=0.91,1.11,P〈0.05）. These three quantitative indicators including OR,OL,and HR were not correlated with curative effect（r=0.11,-0.19,0.26,P〉0.05）. The area under the curve of OR was 0.66 and the cut-off value was 67.50 min. Conclusion For IBS-D patients,the quantitative indicators calculated from RI combined with LHBT method could be used for diagnosing SIBO and especially for OR but not for therapeutic evaluation.
作者
宁艳丽
陈东方
楼岑
黄中柯
NING Yanli;CHEN Dongfang;LOU Cen(Department of Nuclear Medicine,Hangzhou Xiasha Hospital,Hangzhou 310018,China)
出处
《全科医学临床与教育》
2018年第6期609-612,620,共5页
Clinical Education of General Practice
基金
浙江省科技厅公益技术研究社会发展项目(2014C33176)
关键词
小肠细菌过度生长
肠易激综合征
乳果糖氢呼气试验
核素显像
small intestinal bacterial overgrowth
irritable bowel syndrome
lactulose hydrogen breath test
radionuclide imaging
