Fadeeva N A, Ruchkina I N, Parfenov A I, Shcherbakov P L
Moscow Clinical Research and Practical Center, Moscow Healthcare Department, Moscow, Russia.
Ter Arkh. 2015;87(2):20-23. doi: 10.17116/terarkh201587220-23.
To establish the rate of lactase deficiency (LD) in patients with post-infectious irritable bowel syndrome (PI-IBS), to define a role of enteric bacteria in the pathogenesis of hypolactasia, and to evaluate the efficiency of probiotic therapy.
Examinations were made in 386 patients with PI-IBS, including 112 (79.4%) women; mean age 33.9 ± 9.1 years; disease duration 2.6 ± 1.4 years. Rapid tests of small intestinal mucosa (SIM) biopsy specimens obtained from the duodenal retrobulbar segment were used to diagnose LD. Bacterial growth was estimated by a hydrogen breath test using a H2 MICRO gas analyzer.
The patients with PI-IBS were revealed to have moderate and severe LD in 25.6 and 10.9%, respectively. All the patients with LD were detected to have small intestinal (SI) bacterial overgrowth (BOG). An inverse correlation was found between LD and the degree of SI BOG (r = -0.53; p < 0.001). 73.7% of the patients with moderate LD showed a positive effect of probiotic therapy as regression of clinical symptoms of LD, a decrease of hydrogen levels in expired air from 72.4 ± 25.1 to 16.41 ± 3.2 ppm (p < 0.05), an increase of lactate activity in the SIM biopsy specimens and an improvement of quality of life from 2.69 ± 0.53 to 5.53 ± 0.64 scores according to the GCI scale. No improvement occurred in 73.8% of the patients with severe LD.
LD was identified in 36.5% of the patients with PI-IBS. There was an inverse correlation between the degree of LD and SI BOG. The good therapeutic effect of probiotics in LD suggests that the symbiotic gut microflora positively affects the activity of lactase in the human SIM. No therapeutic effect of probiotics in patients with severe LN serves as the basis for a search for more active probiotic therapy.
确定感染后肠易激综合征（PI-IBS）患者中乳糖酶缺乏（LD）的发生率，明确肠道细菌在乳糖酶缺乏症发病机制中的作用，并评估益生菌治疗的效果。
对386例PI-IBS患者进行检查，其中女性112例（79.4%）；平均年龄33.9±9.1岁；病程2.6±1.4年。采用快速检测十二指肠球后段小肠黏膜（SIM）活检标本的方法诊断LD。使用H2 MICRO气体分析仪通过氢呼气试验评估细菌生长情况。
PI-IBS患者中，中度和重度LD的发生率分别为25.6%和10.9%。所有LD患者均检测出小肠（SI）细菌过度生长（BOG）。发现LD与SI BOG程度呈负相关（r = -0.53；p < 0.001）。73.7%的中度LD患者益生菌治疗效果良好，表现为LD临床症状消退，呼出气体中氢气水平从72.4±25.1降至16.41±3.2 ppm（p < 0.05），SIM活检标本中乳糖酶活性增加，根据GCI量表生活质量评分从2.69±0.53提高到5.53±0.64。73.8%的重度LD患者无改善。
36.5%的PI-IBS患者存在LD。LD程度与SI BOG之间存在负相关。益生菌对LD有良好治疗效果，提示共生肠道微生物群对人SIM中乳糖酶活性有积极影响。益生菌对重度LN患者无治疗效果，这为寻找更有效的益生菌治疗方法提供了依据。
