本文選題：腸易激綜合征 + 乳果糖呼氣試驗(yàn)　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景：腸易激綜合征(irritable bowel syndrome, IBS)是一種全球性常見的慢性消化系統(tǒng)疾病,其特點(diǎn)為腹部不適或腹痛伴排便習(xí)慣和(或)大便性狀改變?yōu)樘卣鞯墓δ苄阅c病,腹部癥狀與排便習(xí)慣改變有明確的相關(guān)性,癥狀可持續(xù)存在或間歇發(fā)作。IBS的病因尚不十分清楚,目前認(rèn)為是由多種因素共同作用引起,近年來(lái)研究認(rèn)為腸道細(xì)菌過度生長(zhǎng)(small intestinal bacteria overgrowth, SIBO)可能在發(fā)病機(jī)制中占有重要地位,并且廣泛參與了IBS的病理生理過程,研究結(jié)果表明IBS患者普遍存在SIBO。乳果糖呼氣試驗(yàn)(The lactulose breath test, LBT)是使用不被人體腸道吸收的乳果糖作為底物,腸道細(xì)菌能夠分解發(fā)酵乳果糖產(chǎn)生氣體,通過儀器定性或定量檢測(cè)腸道中細(xì)菌產(chǎn)生的氣體,是目前檢測(cè)SIBO的重要手段。存在SIBO的患者在LBT時(shí)會(huì)產(chǎn)生氫氣和甲烷,而IBS患者普遍存在氣體相關(guān)癥狀如腹脹、胃脹、腹痛等,氣體的產(chǎn)生及氣體體積的大小可能是導(dǎo)致上述癥狀的重要原因。 目的：本研究旨在通過測(cè)量IBS患者乳果糖呼氣試驗(yàn)中氫氣和甲烷的產(chǎn)生,收集患者胃腸道相關(guān)癥狀的嚴(yán)重程度評(píng)分,比較乳果糖呼氣試驗(yàn)的陽(yáng)性結(jié)果以及產(chǎn)生的氣體與IBS患者癥狀的相互關(guān)系。 研究對(duì)象與方法：選擇2013年6月到2014年4月到本院消化內(nèi)科門診及住院治療、符合羅馬Ⅲ診斷標(biāo)準(zhǔn)的IBS患者43例,來(lái)自本院身體健康的職工16例。所有受試者均接受乳果糖呼氣試驗(yàn),IBS患者填寫癥狀視覺模擬評(píng)分表。LBT陽(yáng)性被定義為氫氣濃度基礎(chǔ)值大于20ppm,或在90分鐘內(nèi)上升達(dá)到20ppm；甲烷濃度基礎(chǔ)值大于10ppm,或在90分鐘內(nèi)上升達(dá)到10ppm。通過計(jì)算產(chǎn)生的氫氣或甲烷濃度曲線下面積獲得氣體體積。比較IBS患者和對(duì)照組LBT陽(yáng)性率,比較IBS各亞型LBT陽(yáng)性率及癥狀評(píng)分。根據(jù)呼氣結(jié)果將IBS患者分為L(zhǎng)BT(H2)陽(yáng)性組、禁食后LBT(H2)陽(yáng)性組、LBT(CH4)陽(yáng)性組和LBT陰性組,分別記錄患者的癥狀評(píng)分,SIBO陽(yáng)性率,呼氣所有濃度值和氣體產(chǎn)生量。通過對(duì)IBS患者各組和對(duì)照組陽(yáng)性率、呼氣氫濃度值和氣體產(chǎn)生量比較,進(jìn)一步證實(shí)在LBT試驗(yàn)中氣體的產(chǎn)生和IBS癥狀之間的關(guān)系。 結(jié)果：1.IBS患者的LBT陽(yáng)性率高于健康對(duì)照組(P=0.009),女性IBS患者的LBT陽(yáng)性率要高于男性患者(P=0.017), IBS各亞組之間的LBT陽(yáng)性率無(wú)明顯差別,IBS-D患者LBT結(jié)果主要為H2陽(yáng)性(66.7%),IBS-C患者LBT結(jié)果主要為CH4陽(yáng)性(38.5%),LBTCH4)陽(yáng)性受試者的年齡要大于LBT陰性結(jié)果的受試者(p0.01)；2.LBT陽(yáng)性IBS患者氫氣體積大于LBT陰性的IBS患者(P0.001)和LBT陽(yáng)性的對(duì)照組受試者氫氣體積(P=0.024),IBS-C患者所產(chǎn)生的甲烷體積大于IBS-D患者(P=0.045), LBT陽(yáng)性受試者的平均氣體體積大于LBT陰性的受試者(P=0.02);3. LBT陽(yáng)性的IBS患者脹氣(P=0.02)、腹脹(P=0.02)和便秘(P=0.01)癥狀評(píng)分均高于LBT陰性的患者,LBT(H2)陽(yáng)性患者的腹脹(P=0.009)和脹氣癥狀評(píng)分(P=0.036)均高于LBT(H2)陰性的患者,而LBT(CH4)陽(yáng)性患者的便秘癥狀評(píng)分高于LBT(CH4)陰性的患者(P=0.002),禁食后LBT(H2)陽(yáng)性患者的腹痛(P=0.04)、腹脹(P=0.03)和脹氣(P=0.001)癥狀評(píng)分高于非禁食后LBT(H2)陽(yáng)性的患者；4.氣體總體積與腹脹(r=0.323,P=0.035)、腹痛(r=0.447,P0.001)和便秘(r=0.326,P=0.033)癥狀存在相關(guān)性。 結(jié)論：IBS患者中SIBO有較高的發(fā)生率,IBS發(fā)病與SIBO有一定相關(guān)性；LBT時(shí)產(chǎn)生的H2與CH4與IBS患者的具體癥狀有關(guān)；通過計(jì)算H2與CH4濃度曲線下面積得到的氣體體積與IBS患者的癥狀嚴(yán)重程度也存在相關(guān)性。我們的實(shí)驗(yàn)結(jié)果表明,LBT時(shí)產(chǎn)生的H2和CH4可用于預(yù)測(cè)IBS患者的相關(guān)癥狀。
[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.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R574.4

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本文編號(hào)：1732372