Portincasa P, Di Ciaula A, Vacca M, Montelli R, Wang D Q-H, Palasciano G
Department of Internal Medicine and Public Medicine, University Medical School, Bari, Italy.
Eur J Clin Invest. 2008 Nov;38(11):835-44. doi: 10.1111/j.1365-2362.2008.02035.x.
A lactose-free diet is commonly prescribed to subjects with hypolactasia. We tested the effectiveness of a single ingestion of tilactase (a beta-D-galactosidase from Aspergillus oryzae) in adults with hypolactasia, previously assessed by lactose H(2)-breath test.
After measurement of orocecal transit time (OCTT, by lactulose H(2)-breath test) and lactose H(2)-breath testing plus placebo, a total of 134 subjects were positive to hypolactasia and underwent lactose H(2)-breath testing plus either low (6750 U) or standard (11,250 U) doses of tilactase. The appearance of gastrointestinal symptoms during the tests was monitored.
OCTT was longer in malabsorbers (subjects without bloating, abdominal pain and/or diarrhoea, n = 25) than in intolerants (bloating, abdominal pain and/or diarrhoea, n = 109, P < 0.02). Malabsorbers had longer time to H(2) peak (P < 0.03), lower H(2) peak levels (P < 0.002) and smaller integrated H(2) excretion levels (P < 0.005) than intolerants. After tilactase ingestion, integrated H(2) levels were decreased by 75% (low dose) and 87% (standard dose) in malabsorbers, and by 74% (low dose) and 88% (standard dose) in intolerants. In the latter group, total symptom score were decreased by 76% (low dose) and by 88% (standard dose) (P < 0.0001).
A single oral administration of tilactase is highly effective in decreasing symptoms and hydrogen excretion of hypolactasia assessed by lactose H(2)-breath test. If confirmed by long-term observations, ingestion of tilactase might be a better option than exclusion diets in intolerant subjects with hypolactasia.
对于乳糖不耐受的患者，通常会建议采用无乳糖饮食。我们测试了一次性摄入嗜热栖热放线菌β-D-半乳糖苷酶（tilactase）对乳糖不耐受成人的有效性，这些成人之前已通过乳糖氢呼气试验进行了评估。
在测量口盲肠转运时间（通过乳果糖氢呼气试验）以及进行乳糖氢呼气试验加安慰剂测试后，共有134名乳糖不耐受检测呈阳性的受试者接受了乳糖氢呼气试验加低剂量（6750 U）或标准剂量（11250 U）的tilactase测试。在测试过程中监测胃肠道症状的出现情况。
吸收不良者（无腹胀、腹痛和/或腹泻的受试者，n = 25）的口盲肠转运时间比不耐受者（有腹胀、腹痛和/或腹泻的受试者，n = 109，P < 0.02）更长。吸收不良者达到氢气峰值的时间更长（P < 0.03），氢气峰值水平更低（P < 0.002），累积氢气排泄水平更小（P < 0.005），均低于不耐受者。摄入tilactase后，吸收不良者累积氢气水平降低了75%（低剂量）和87%（标准剂量），不耐受者降低了74%（低剂量）和88%（标准剂量）。在后一组中，总症状评分降低了76%（低剂量）和88%（标准剂量）（P < 0.0001）。
通过乳糖氢呼气试验评估，一次性口服tilactase在减轻乳糖不耐受症状和氢气排泄方面非常有效。如果长期观察得到证实，对于乳糖不耐受的受试者，摄入tilactase可能比排除饮食是更好的选择。
