Fitriakusumah Yoga, Lesmana C Rinaldi A, Bastian Winda Permata, Jasirwan Chyntia O M, Hasan Irsan, Simadibrata Marcellus, Kurniawan Juferdy, Sulaiman Andri Sanityoso, Gani Rino A
Department of Internal Medicine, Hepatobiliary Division, Dr. Cipto Mangunkusumo National General Hospital, Universitas Indonesia, Jakarta, Indonesia.
Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.
BMC Gastroenterol. 2019 Mar 20;19(1):43. doi: 10.1186/s12876-019-0960-x.
Non-alcoholic fatty liver disease (NAFLD) is an emerging disease, where it can progress to non-alcoholic steatohepatitis (NASH) and lead to liver cirrhosis or liver cancer. Small intestinal bacterial overgrowth (SIBO) has been hypothesized to play an important role in NAFLD development and progression, however, there is still conflicting data about this phenomenon. Transient Elastography (TE) examination using controlled attenuation parameter (CAP) has been validated for liver disease progression assessment in NAFLD. It is non-invasive method and easy to perform in clinical practice. Therefore, we would like to know the role of SIBO in NAFLD and its possible impact on disease progression.
A cross-sectional design study performed at outpatient's Hepatobiliary clinic at tertiary referral university hospital in Jakarta. All recruited study subjects based on inclusions criteria underwent laboratory examination, transabdominal ultrasound examination, CAP-TE 502 (by Echosens, France), and glucose hydrogen breath test (GHBT) using portable hydrogen breath test apparatus (Gastro+™ Gastrolyzer by Bedfont Scientific Ltd). Stool sample examination was performed using RT-PCR.
This study recruited 160 subjects with median age of 58 (22-78) years and 108 (67.5%) of them are female. SIBO (65,5%), DM (70.8%), dyslipidemia (75.2%), obesity (76.6%), and metabolic syndrome (73%) were more prevalent in NAFLD than non-NAFLD population. Bivariate analysis showed no significant association between SIBO and NAFLD development (p = 0.191; PR 0.871; CI 95% [0.306-1.269]). SIBO was also not associated with significant hepatic steatosis (p = 0.951; PR = 0.951; CI 95% [0.452-2.239]) and fibrosis (p = 0.371; PR = 1.369; CI 95% [0.608-3.772]). However, the presence of central obesity has significantly associated with the presence of SIBO (p = 0.001; PR = 0.378; CI 95% [0.021-0.478]). Based on stool sample analysis from 60 NAFLD patients, there is a significant correlation using Spearmen test between the presence of Bacteroides and the stage of fibrosis (p .037). Further analysis between obese NAFLD patients and non-obese NAFLD patients showing that there is a significant decrease of Bifidobacteria (p .047) and Lactobacillus (p .038) in obese NAFLD patients and a tendency of increase Bacteroides in obese NAFLD patients (p .572).
SIBO is not associated with NAFLD development and progression.
非酒精性脂肪性肝病（NAFLD）是一种新兴疾病，可进展为非酒精性脂肪性肝炎（NASH），并导致肝硬化或肝癌。小肠细菌过度生长（SIBO）被认为在NAFLD的发生和发展中起重要作用，然而，关于这一现象的数据仍存在矛盾。使用受控衰减参数（CAP）的瞬时弹性成像（TE）检查已被验证可用于评估NAFLD的肝病进展。它是一种非侵入性方法，在临床实践中易于操作。因此，我们想了解SIBO在NAFLD中的作用及其对疾病进展的可能影响。
在雅加达一所三级转诊大学医院的门诊肝胆科进行了一项横断面设计研究。所有符合纳入标准的研究对象均接受了实验室检查、经腹超声检查、CAP-TE 502（由法国Echosens公司提供）以及使用便携式氢气呼气试验仪（Bedfont Scientific Ltd公司生产的Gastro+™ Gastrolyzer）进行的葡萄糖氢气呼气试验（GHBT）。使用逆转录聚合酶链反应（RT-PCR）进行粪便样本检查。
本研究招募了160名受试者，中位年龄为58岁（22 - 78岁），其中108名（67.5%）为女性。与非NAFLD人群相比，SIBO（65.5%）、糖尿病（DM，70.8%）、血脂异常（75.2%）、肥胖（76.6%）和代谢综合征（73%）在NAFLD中更为普遍。二元分析显示SIBO与NAFLD的发生之间无显著关联（p = 0.191；PR 0.871；95%置信区间[0.306 - 1.269]）。SIBO也与显著的肝脂肪变性（p = 0.951；PR = 0.951；95%置信区间[0.452 - 2.239]）和纤维化（p = 0.371；PR = 1.369；95%置信区间[0.608 - 3.772]）无关。然而，中心性肥胖的存在与SIBO的存在显著相关（p = 0.001；PR = 0.378；95%置信区间[0.021 - 0.478]）。基于对60例NAFLD患者粪便样本的分析，使用Spearman检验发现拟杆菌的存在与纤维化阶段之间存在显著相关性（p < 0.037）。对肥胖NAFLD患者和非肥胖NAFLD患者的进一步分析表明，肥胖NAFLD患者中双歧杆菌（p < 0.047）和乳酸杆菌（p < 0.038）显著减少，且肥胖NAFLD患者中拟杆菌有增加的趋势（p = 0.572）。
SIBO与NAFLD的发生和进展无关。
