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目的了解功能性消化不良(FD)中小肠细菌过度生长(SIBO)的发生率,推测临床预测因子并观察米曲菌胰酶片对FD合并SIBO的疗效。方法对112例符合罗马Ⅲ标准的FD患者进行第1次LHBT(f-LHBT),其结果使用Logistic回归分析LHBT阳性的预测因子。26例f-LHBT阳性者随机接受加酶或非加酶治疗,2周后复查LHBT(LHBT-2w),对LHBT-2w持续阳性者继续加酶治疗2周后再次复查LHBT(LHBT-4w)。比较加酶组与非加酶组间症状改善情况及复查LHBT情况。结果 112例FD中,33例(29.46%)f-LHBT阳性,Logistic回归提示上腹胀程度(OR=1.759,95%CI:1.187~2.609)、恶心程度(OR=1.634,95%CI:1.029~2.594)是LHBT阳性的独立预测因子。治疗2周后,两组共17例患者(65.38%)出现LHBT-2w阴转,其症状改善率高于LHBT-2w持续阳性组(t=-2.833,P=0.009)。加酶组(n=14)症状改善率为(75.89±21.92)%、非加酶组(n=12)为(53.84±31.39)%,差异有统计学意义(t=2.100,P=0.046)。加酶组LHBT-2w阴转率为71.4%,非加酶组为58.3%,差异无统计学意义(P=0.683),但加酶组高峰呼气H2浓度减少率显著高于非加酶组(U=-2.315,P=0.021)。7例LHBT-2w持续阳性者经继续加酶治疗2周后复查LHBT-4w,结果4例阴转,3例仍持续阳性,但高峰呼气H_2浓度均有所下降。结论大约29%FD患者会合并SIBO,上腹胀程度及恶心程度是独立预测因子。SIBO转阴后消化不良症状改善,提示FD症状可能与SIBO有关。短期使用米曲菌胰酶片可促进这些患者的症状改善,可能与减少SIBO有关。
Objective To investigate the incidence of intestinal bacterial overgrowth (SIBO) in functional dyspepsia (FD) and to predict the clinical predictors and to observe the curative effect of Aspergillus oryzae trypsin on FD combined with SIBO. Methods The first LHBT (f-LHBT) was performed on 112 patients with FD with Rome Ⅲ criteria. The results were analyzed using Logistic regression to predict the LHBT positive predictive value. Twenty-six patients with positive f-LHBT were randomized to receive LHBT-2w (LHBT-2w) after two weeks and LHBT-2w (LHBT-2w) . Compare the improvement of symptom between plus enzyme group and non-plus enzyme group and review LHBT situation. Results In 112 cases of FD, 33 (29.46%) were positive for f-LHBT. Logistic regression showed that the degree of abdominal distention (OR = 1.759, 95% CI: 1.187-2.609) and nausea (OR = 1.634, 95% CI: 2.594) is an independent predictor of LHBT positive. After 2 weeks of treatment, 17 patients (65.38%) in both groups had negative LHBT-2w and the improvement rate was higher than that in LHBT-2w group (t = -2.833, P = 0.009). (75.89 ± 21.92)% in the enzyme group (n = 14) and (53.84 ± 31.39)% in the non-enzyme group (n = 12), the difference was statistically significant (t = 2.100, P = 0.046) . The negative conversion rate of LHBT-2w was 71.4% in addition enzyme group and 58.3% in non-addition enzyme group, the difference was not statistically significant (P = 0.683), but the decrease rate of peak expiratory H2 concentration in addition enzyme group was significantly higher than that in non-addition enzyme group (U = -2.315, P = 0.021). Seven patients with LHBT-2w persistent positive returned to LHBT-4w after 2 weeks of continuous enzyme treatment. The results showed that 4 cases were negative and 3 cases continued to be positive, but the peak expiratory H 2 concentration decreased. Conclusion Approximately 29% of FD patients have SIBO, and the degree of abdominal distension and the degree of nausea are independent predictors. SIBO negative after the improvement of indigestion, suggesting that symptoms of FD may be related to SIBO. Short-term use of aspergillulastin tablets may improve the symptoms of these patients, which may be related to the reduction of SIBO.