The Clinical Study Of Small Intestinal Bacterial Overgrowth In Patients With Fatty Liver Disease

Objective:Lactulose hydrogen breath test(LHBT)was used to detect the incidence of Small intestinal bacterial overgrowth(SIBO)in patients with fatty liver disease(FLD),to analyze its clinical features and evaluate the efficacy of rifaximin combined with probiotics on SIBO in patients with FLD,to provide a theoretical basis for clinical prevention and treatment of FLD.Methods:A total of 84 FLD patients who were treated at the Second Hospital of Hebei Medical University from January 1,2020 to December 31,2020 were included in this study,including 49non-alcoholic fatty liver disease(NAFLD).and 35 alcoholic fatty liver disease(ALD).At the same time,20 healthy people who came to our hospital for routine physical examination were selected as the healthy control group.Collected the clinical data of all patients,and tested the blood routine,liver function,blood lipids,C-reactive protein and other indicators.detected the difference in the incidence of SIBO between FLD patients and healthy controls,NAFLD patients and ALD patients through LHBT,analyzed the related factors of SIBO in FLD patients,and evaluated the clinical efficacy of rifaximin combined with live Bacillus licheniformis granules in patients with FLD and SIBO.Results:1.There were 84 cases in the FLD group,with a SIBO positive ra te of 57.14%(48/84),and 2 cases in the healthy control group with a SIBO positive rate of 10%(2/20).The FLD group’s SIBO positive rat e was significantly higher than that in the healthy control group(P< 0.001);the positive rates of SIBO in the NAFLD group and the ALD gr oup were 51.02%(25/49)and 65.71%(23/35),respectively.There was no significant difference between the two groups(P=0.18),but both wer e higher than the healthy control Group(P<0.001).2.The basal value of methane in the FLD group was higher than that in the healthy control group(P=0.014),and the basal value of hydrogen in the FLD group was not statistically different from that in the healthy control group(P>0.05).The basal value of methane in the ALD group was higher than that of the healthy control group(P=0.045).There was no statistical difference between the NAFLD group and the ALD group,NAFLD and the healthy control group.There was no significant difference in hydrogen basal value among NAFLD group,ALD group and healthy control group(P>0.05).3.Alanine aminotransferase(ALT),alanyl glutamyl transpeptidase(AST),and triglycerides(TG)in the SIBO positive group were higher than the SIBO negative group,and the SIBO negative group was higher than the healthy control group(P<0.001);BMI,total cholesterol(TC),and alanyl glutamyl transpeptidase(GGT)were not significantly different between the SIBO-positive group and the SIBO-negative group(P>0.05),but Both groups were higher than the healthy control group(P<0.001).There was no statistical difference among the three groups in total bilirubin(TBIL),white blood cell count(WBC),percentage of neutrophils(NE),C reactive protein(CRP)(P>0.05).4.The incidence of abdominal distension in the SIBO positive group was higher than that of the SIBO negative group,and the SIBO negative group was higher than the healthy control group(P<0.001);the incidence of abdominal pain,abdominal discomfort,and diarrhea was not statistically different between the SIBO positive group and the SIBO negative group(P> 0.05),but the both groups were higher than the healthy control group(P<0.05);the incidence of nausea and loss of appetite were not statistically significant among the three groups(P>0.05)5.Whether FLD patients were complicated by type 2 diabetes is statistically different between the SIBO positive group and the SIBO negative group,the SIBO positive group and the healthy control group(P<0.05),and there is no statistical difference between the SIBO negative group and the healthy control group(P>0.05)).Whether FLD patients were complicated by coronary heart disease and hypertension was not statistically significant among the three groups(P>0.05).6.After 44 patients with FLD and SIBO were treated with rifaximin combined with live Bacillus licheniformis granules,the total effective rate of clinical symptom improvement reached 79.55%,and the total negative conversion rate of SIBO reached 52.38% after reexamination of LHBT in 21 cases.The incidence of adverse reactions was 4.55%.Conclusions:1.The incidence of SIBO in FLD patients was significantly higher than that in healthy controls,and there was no significant difference in the incidence of SIBO in NAFLD and ALD patients;the basal value of methane increased more significantly in FLD,especially in ALD patients,suggesting that SIBO is involved in the occurrence of NAFLD and ALD.2.SIBO has a higher incidence in FLD patients with elevated ALT,AST,TG and type 2 diabetes,and abdominal distension is the main cl inical manifestation.3.Rifaximin combined with probiotics can effectively improve clinical symptoms such as abdominal distension,abdominal pain,and abdominal discomfort by inhibiting the occurrence of SIBO in FLD patients,and provide a theoretical basis for clinical FLD treatment.