摘要目的 探讨小剂量、短程利福昔明口服疗法对小肠细菌过度生长(SIBO)相关IBS患者的临床疗效.方法 顺序纳入2017年6月至2018年6月就诊于复旦大学附属华山医院消化内科的37例SIBO相关IBS患者,分成腹泻型、便秘型、混合型3组,均采用利福昔明(200 mg/次,3次/d)进行为期14 d的治疗.应用肠易激综合征症状严重程度量表(IBS-SSS)和肠易激综合征相关生命质量(IBS-QoL)量表评分比较治疗前后的临床疗效.采用乳果糖呼气试验(LBT)和呼出气一氧化氮(eNO)检测观察治疗SIBO及其相关慢性低度炎症反应的疗效.统计学方法为t检验和方差分析.结果 37例SIBO相关IBS患者中,腹泻型24例,便秘型7例,混合型6例.除1例患者因胸闷、心悸退出研究外,其余36例患者治疗前IBS-SSS评分为(250.83±55.10)分,治疗后降至(151.11±33.96)分,差异有统计学意义(t=13.686,P<0.01);治疗前IBS-QoL评分为(28.03±16.16)分,治疗后降至(14.39±9.31)分,差异有统计学意义(t=6.867,P<0.01).腹泻型、便秘型和混合型IBS组之间的IBS-SSS评分和IBS-QoL评分差异均无统计学意义(P均>0.05).采用利福昔明治疗后,SIBO转阴率为52.8％(19/36),其中氢气LBT转阴率为54.5％(12/22),11例甲烷LBT阳性患者中转阴6例,3例两者均阳性患者中转阴1例;eNO转阴率为41.7％(15/36).结论 小剂量、短程利福昔明治疗可改善SIBO相关IBS患者的症状严重程度和生命质量,疗效与I B S亚型无关.

abstractsObjective To investigate the efficacy of low dose and short-term oral rifaximin in patients with small intestinal bacterial overgrowth (SIBO)related irritable bowel syndrome (IBS). Methods From June 2017 to June 2018,at the Department of Gastroenterology of Huashan Hospital,Fudan University in Shanghai,a total of 37 patients with SIBO related IBS were sequentially enrolled and divided into three groups:diarrhea type,constipation type and mixed type. All the patients received rifaximin 200 mg each time,three times per day for 14 days. The clinical efficacy before and after treatment were compared by the scores of irritable bowel syndrome symptom severity scale (IBS-SSS)and irritable bowel syndrome associated quality of life (IBS-QoL). The efficacy of rifaximin on SIBO clearance and SIBO related chronic low-grade inflammation was evaluated by lactulose breath test (LBT)and exhaled nitric oxide (eNO). T test and variance analysis were used for statistical analysis. Results Among 39 patients with SIBO related IBS,24 patients were diarrhea type,seven were constipation type and six were mixed type. Except one patient quitted the study because of chest tightness and palpitation,the IBS-SSS score of the left 36 patients before treatment was (250. 83 ± 55. 10),and decreased to (151. 11 ± 33. 96),and the difference was statistically significant (t = 13. 686,P <0. 01). Before treatment the score of IBS-QoL was (28. 03 ± 16. 16),and decreased to (14. 39 ± 9. 31)after treatment,and the difference was statistically significant (t = 6. 867,P < 0. 01 ). There was no significant difference in IBS-SSS and IBS-QoL scores among the diarrhea type,constipation type and mixed type groups (all P > 0. 05). After treated by rifaximin,the negative conversion rate of SIBO was 52. 8％(19 / 36). The negative conversion rate of hydrogen LBT was 54. 5％(12 / 22)and among 11 methane LBT positive patients,six cases turned negative;and one of three patients with both positive hydrogen LBT and methane LBT turned negative. The negative conversion rate of eNO was 41. 7％ (15 / 36). Conclusions Low dose and short term rifaximin treatment can improve the severity of clinical symptoms and quality of life in SIBO-related IBS patients,and the efficacy is not related with the subtypes of IBS.