| BackgroundIn china,hepatic cirrhosis is a common disease in the digestive system,and it is the final stage of the development of multiple chronic liver diseases.The liver and the intestine stay in close contact through the "intestine-liver axis".When hepatic cirrhosis occurs,the intestinal microenvironment will be affected by impaired function of the liver and increased portal pressure,directly or indirectly.Increasing studies have shown that the translocation of intestinal flora is closely related to the occurrence and development of cirrhosis.The displacement of intestinal flora during liver cirrhosis is mainly related to several factors: increased intestinal permeability,intestinal bacterial overgrowth,and body?s immunity is reduced.Among them,intestinal bacterial overgrowth is the most important factor in promoting the migration of bacteria.Small intestinal bacterial overgrowth(SIBO),also known as small bowel contamination syndrome or blind pupa syndrome,is caused by a change in the number of intestinal bacteria and microbial flora caused by translocation of intestinal flora,manifested as abdominal distention,diarrhea,Symptoms of nutritional malabsorption and other clinical syndromes that overlap with clinical tract symptoms of hepatic cirrhosis.A large number of studies have found that the SIBO positive rate in patients with liver cirrhosis is significantly higher than that in healthy people,and there are reports in the literature that antibiotic treatment to eradicate bacterial overgrowth in the small intestine can improve the symptoms of patients with hepatic cirrhosis.The purpose of this study was to use the lactulose hydrogen and methane breath test(LHMBT)to measure the concentrations of hydrogen and methane in the exhaled breath of patients and to determine the positive rate of SIBO in patients with hepatic cirrhosis,the relationship between SIBO and cirrhosis.The breath test results of hydrogen and methane at various time points were analyzed and compared,and the clinical value of methane breath test in the diagnosis of SIBO in patients with hepatic cirrhosis whose hydrogen breath test is negative was studied.ObjectiveTo study the hepatic cirrhosis patients? incidence of small intestinal bacterial overgrowth,the relationship between SIBO and hepatic cirrhosis,and the variation in methane when hydrogen breath test is negative,thereby to investigate the application value of methane breath test on hepatic cirrhosis patients without hydrogen.Thus providing new clues for treatment and prognosis of hepatic cirrhosis.MethodsWe collected the diagnoses from the First Affiliated Hospital of Zhengzhou University from May 2016 to April 2017 that met the standard of viral hepatitis prevention and treatment revised jointly by the National Institute of Infectious Diseases and Parasitic Diseases and the Society of Liver Diseases in Xi'an in September 2000.70 cases of hepatic cirrhosis patients and 30 healthy subjects whose age and sex matched each other in the same period.Through the lactulose methane-hydrogen breath test,we calculated the incidence of SIBO,the number of hydrogen in the basic exhalation that was no less than 20 ppm,the number of hydrogen and methane that exhibited typical double peak patterns,the hydrogen and methane concentrations at various time points,and the incidence of non-production of hydrogen and the change in methane concentration at this time.Results1 SIBO positive rates in patients with liver cirrhosis and healthy controls were 67.14% and 33.33%,respectively(P<0.05).2 The basal expiratory hydrogen concentrations in the hepatic cirrhosis patients group and the healthy control group were(18.86±14.16)ppm and(5.97±2.86)ppm,(P<0.05),and the concentrations of methane in the basic expiratory breath were(9.50±7.23)ppm and(3.97 ± 1.90)ppm(P< 0.05),respectively;There are 32 patients(45.71%)in the cirrhotic group whose basal hydrogen concentration was no less than 20 ppm,and there was no case in the healthy control group whose concentration of hydrogen in the basic exhalation of was no less than 20 ppm(P<0.05).3 The number of typical double-peak patterns in the curves of hydrogen and methane in patients with hepatic cirrhosis and healthy controls was 22(31.43%)and 3(10.00%),respectively(P<0.05).4 In the SIBO positive cirrhotic patient group,there was 8 patients(17.02%)whose hydrogen breath test was negative,while only one case(10.00%)did not produce hydrogen in the SIBO positive healthy control group(P>0.05).At this time,the methane concentrations of both groups showed a significant upward trend.5 Differences in hydrogen and methane concentrations at each time point between the cirrhotic patient group and the healthy control group were statistically significant(P<0.05).Conclusions1 The incidence of SIBO in patients with hepatic cirrhosis was significantly higher than that in healthy controls,indicating that SIBO is associated with cirrhosis,and SIBO is more likely to occur in patients with hepatic cirrhosis.2 The methane breath test had a significant effect on the supplementary diagnosis of SIBO in cirrhotic patients with negative hydrogen breath test. |
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