Nutrition status and small intestinal bacterial overgrowth in patients with virus - related cirrhosis

病毒相关肝硬化患者营养状态和小肠细菌过度生长关系的研究

Jia Yao ； Le Chang ； Lili Yuan ； Zhongping Duan

《Asia Pacific Journal of Clinical Nutrition》 25卷2期 (2016/06) Pp. 283-291

https://doi.org/10.6133/apjcn.2016.25.2.06

摘要

肝硬化患者常常合并营养不良和小肠细菌过度生长（SIBO），但是，营养状态和SIBO是否直接相关并未阐明。因此，本研究旨在探讨乙型肝炎（HBV）或丙型肝炎（HCV）相关的肝硬化患者的营养状态和SIBO的关系。本研究入组HBV或者HCV相关的肝硬化患者120名，健康对照30名。根据主观全面营养评估法（SGA）和人体测量学评价入组肝硬化患者的营养状态。所有入组患者及健康对照组均进行氢呼气检测。HBV或者HCV相关的肝硬化患者在中国的营养不良患病率率为19.4%60%。SGA检测法的营养不良检测率最高，三头肌皮褶厚度检测法的营养不良检测率最低。在营养不良（SGA-B/C）的肝硬化患者中的SIBO的发生率明显高于营养良好（SGA-A）患者[41/72 (56.9%)vs 12/48 (25.0%) (p=0.001)]。单因素分析显示：SIBO、腹水和Child–Turcotte–Pugh（CTP）分级与营养不良相关。多因素分析显示：SIBO [OR 8.10，p=0.002]和腹水(OR 4.56，p=0.022)是营养不良的独立危险因素。因此，在HBV或者HCV相关的肝硬化患者中，SIBO与营养不良（SGA-B/C）独立相关。从而，我们认为SIBO对于病毒相关的肝硬化患者的营养状态可能有重要的影响。

關鍵字

营养状态 ； 小肠细菌过度生长 ； 乙型肝炎 ； 丙型肝炎 ； 肝硬化

並列摘要

Malnutrition and small intestinal bacterial overgrowth (SIBO) is frequently present in patients with liver cirrhosis (LC). However, the direct relationship between SIBO and nutrition status in the LC patients has not been elucidated. The aim of this study was to investigate whether there was an association between nutrition status, evaluated by the subjective global assessment (SGA) and SIBO in patients with Hepatitis B virus (HBV) or hepatitis C virus (HCV) related cirrhosis. A total of 120 patients with HBV or HCV-related cirrhosis and 30 healthy controls were included. Nutritional status was determined according to SGA and anthropometry. All patients and healthy controls underwent a glucose hydrogen breath test for SIBO. The prevalence of malnutrition for the patients with HBV or HCV related cirrhosis ranged 19.4%-60% in China. The highest prevalence of malnutrition was detected by SGA, the lowest by triceps skinfold thickness. The frequency of SIBO was significantly higher in the malnourished (SGA-B/C) than in the well-nourished (SGA-A) patients with HBV or HCV related cirrhosis [41/72 (56.9%) vs 12/48 (25.0%) (p=0.001)]. Univariate analysis showed that SIBO, ascites, and Child-Turcotte-Pugh (CTP) class were associated with malnutrition. Multivariate analysis demonstrated that SIBO [odds ratio (OR) 8.10; p=0.002] and ascites (OR 4.56; p=0.022) were independently associated with the occurrence of malnutrition (SGA-B/C) in the same subjects. SIBO is independently related to the occurrence of malnutrition (SGA-B/C) in patients with HBV or HCV cirrhosis. We deduce that SIBO may play an important role in nutrition status in patients with HBV or HCV cirrhosis.

並列關鍵字

nutritional status ； small intestinal bacterial overgrowth ； hepatitis B ； hepatitis C ； liver cirrhosis