论文部分内容阅读
近段小肠分泌液常无菌或仅有少许唾液型革兰氏阳性细菌。胃酸和正常小肠运动是防止小肠细菌过度繁殖(SIBO)的最重要因素,肠腔内免疫球蛋白A(IgA)可能也起一定作用。唾液型SIBO无多大临床意义,而对有营养缺乏(包括维生素B12)和腹泻、厌食、恶心症状者革兰氏阳性结肠菌型SIBO是一种重要的临床病症。上述症状常见于老年人,难用其他肠道病解释。无创性呼吸试验结果不可靠,并且不能区别唾液型和结肠型SIBO。作者用细菌培养方法对无临床易患疾病和维生素B12缺乏的老年人结肠型SIBO的发病情况进行了研究,并对胃酸、小肠运动和腔内IgA浓度与SIBO的关系进行了评价。材料和方法 52例合乎标准的患者参加研究,其中16例<50岁,14例50～74岁,22例≥75岁。36例有慢性腹泻、厌食、恶心三个月以上,其中12例<50岁,10例50～74岁,14例≥75岁。16例有消化不良症状。均排除了其他易患疾病及有关药物史。患者经无菌内镜技术吸取胃液和近段小肠液,分别做特殊或普通培养基细菌培养。内镜检查前留唾液做细菌培养。测定空腹胃酸,pH>4为低胃酸。唾液型SIBO的定义为活菌计数(轻型、唾液型链球
Recent intestinal secretions often sterile or only a small amount of salivary Gram-positive bacteria. Gastric acid and normal small intestine movement are the most important factors in preventing SIBO. Intestinal luminal IgA may also play a role. Salivary SIBO is of little clinical significance, and Gram-positive coliform SIBO is an important clinical condition in patients with nutritional deficiencies (including vitamin B12) and diarrhea, anorexia, and nausea. These symptoms are common in the elderly, difficult to explain with other intestinal diseases. Noninvasive breath test results are not reliable and can not distinguish between salivary and colonic SIBO. The authors used bacterial culture to study the incidence of colon-type SIBO in elderly individuals without clinically predisposed disease and vitamin B12 deficiency and evaluated the relationship between gastric acid, small intestine motility and intraluminal IgA concentration and SIBO. Materials and Methods Fifty-two eligible patients participated in the study, of which 16 were <50 years, 14 were 50 to 74 years and 22 were ≥75 years. 36 cases had chronic diarrhea, anorexia and nausea for more than three months, of which 12 cases were <50 years old, 10 cases were 50-74 years old and 14 cases were ≥75 years old. 16 cases of dyspepsia symptoms. All other diseases and related drug history were excluded. Patients by endoscopic aseptic technique to absorb gastric juice and proximal intestinal fluid, respectively, to do special or ordinary culture medium. Salivary bacterial culture before endoscopy. Determination of fasting acid, pH> 4 for low stomach acid. Salivary SIBO is defined as a viable count (light, salivary hammer-type