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关于小肠细菌过度生长国际共识和指南的解读
作者:丁文京
版权:国作登字-2022-A-10011119
前言
二、关于小肠细菌过度生长诊断方法
三、关于呼气试验的标准与程序
四、未来展望与思考
前言
小肠细菌过度生长(Small Intestinal Bacterial Overgrowth, SIBO,或Small Bowel Bacterial Overgrowth,SBBO)是一种发病原因复杂的综合征。最早关于小肠细菌过度生长的研究文献可以追溯到1968年Kim和Spritz 发表在《脂质研究杂志》上的文章“实验性盲肠脂肪酸代谢产生的次级羟基脂肪酸”的动物实验研究报道。该文首次描述报道了给与四环素和排除盲环后,通过减少细菌过度生长明显纠正了脂肪泻(Kim and Spritz. 1968.)。关于人类小肠细菌过度生长最早的文献可以追溯到1969年Parson 等人发表在《美国消化病杂志》上的“小肠假性梗阻伴细菌过度生长”。该文首次描述了一例小肠假性梗阻和细菌过度生长的患者,给予四环素后,情况有明显改善(Parson, et al. 1969.)。
从首次报道小肠细菌过度生长,已经过去了半个世纪,2009年首次发布了《氢呼气试验在胃肠疾病的方法和指征:罗马共识会议》(简称《罗马共识》)(Gasbarrini, et al. 2009.),2017年发布了《胃肠道疾病氢和甲烷呼气试验:北美共识》(简称《北美共识》)(Rezaie, et al. 2017.)。在《北美共识》发表之后2017年《中国医学论坛报》发表“北美共识,事无巨细定标准”的专刊,以及在《专家点评》发表了白涛和侯晓华撰写的“呼气试验北美共识给我国临床实践带来的思考”的文章,提出《北美共识》临床意义大,但我国开展不理想。同年《英国胃肠学会》发表了“氢和甲烷呼气试验2017年美国共识文件回顾及对英国的影响”的文章,解读了《北美共识》中有关呼气试验诊断小肠细菌过度生长的内容,提出迫切需要就方法和报告达成共识(Hobson, et al. 2017.)。之后,英国胃肠学会2019年在其网站发布了《英国胃肠生理学家协会氢和甲烷呼气试验标准化检查方案》(简称《英国方案》)。
2020年发布了《美国胃肠学会临床指南:小肠细菌过度生长》(《简称美国指南》)(Pimentel, et al. 2020.),2021年发布了《欧洲成人和儿童患者氢和甲烷呼气试验适应症、性能和临床影响指南:欧洲胃肠病学、内窥镜检查和营养协会、欧洲神经胃肠病学和运动学会和欧洲儿科胃肠病学、肝病和营养共识》(简称《欧洲指南》)(Hammer, et al. 2021.)多部涉及小肠细菌过度生长的国际共识和临床指南。
本世纪以来,肠道微生物失衡与健康和疾病的关系已经成为医疗领域一个研究热点。作为与临床疾病关系密切的小肠细菌过度生长是值得临床医生和科研人员关注一个领域。就目前已经发布的两项国际共识和两项临床指南可以看到分成欧洲和北美(主要是美国)两种流派。本文就已经发布的国际共识和临床指南解读,希望对加深小肠细菌过度生长的理解和开展临床实践提供参考。
参考文献
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