与小儿肠衰竭小肠细菌过度生长发展相关的因素：一项回顾性队列研究。
Factors Related to the Development of Small-Bowel Bacterial Overgrowth in Pediatric Intestinal Failure: A Retrospective Cohort Study.
机构信息
Transplant and Regenerative Medicine Centre, Toronto, Canada.
Division of Neonatology, Toronto, Canada.
出版信息
JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1280-1284. doi: 10.1002/jpen.1809. Epub 2020 Mar 13.
BACKGROUND
Small bowel bacterial overgrowth (SBBO) is a challenge in the management of pediatric intestinal failure (PIF). Our goal was to determine the proportion of patients treated for SBBO and factors related to its development.
METHODS
We completed a retrospective analysis of PIF patients referred between 2008 and 2014. Data were collected on factors related to intestinal failure (IF) and SBBO. The cohort was stratified on the diagnosis of SBBO and refractory SBBO. Statistical testing completed using t-test, χ test, and logistic regression.
RESULTS
Thirty-five of 102 patients developed SBBO (34%), and 16 (16%) had refractory SBBO. SBBO was more likely in gastroschisis (40.0% vs 19.4%, P = .025), a shorter residual small bowel (SB) (45.4% vs 66.5%, P = .004), and patients were less likely to wean from parenteral nutrition (PN) (51.4% vs 85.1%, P < .0001). Refractory SBBO patients were likely to have gastroschisis (50.0% vs 22.1%, P = .020) and a shorter residual SB and large bowel remaining (23.2% vs 65.9%, P < .0001 and 60.6% vs 79.4%, P = .03, respectively) and less likely to wean from PN (37.5% vs 80.2%, P = .001). Logistic regression demonstrated that longer SB residual was protective (P = .001; odds ratio [OR], 0.95; 95% CI, 0.93-0.99), and short bowel syndrome (SBS) as a cause of IF was a risk factor (P = .001; OR, 0.04; 95% CI, 0.01-0.27).
CONCLUSION
A longer SB remnant was protective against SBBO. Patients with SBBO were more likely to have PIF caused by SBS.
背景
小肠细菌过度生长（SBBO）是小儿肠衰竭（PIF）管理中的一个挑战。我们的目标是确定接受 SBBO 治疗的患者比例以及与 SBBO 发展相关的因素。
方法
我们对 2008 年至 2014 年间转诊的 PIF 患者进行了回顾性分析。收集了与肠衰竭（IF）和 SBBO 相关的因素的数据。根据 SBBO 和难治性 SBBO 的诊断对队列进行分层。使用 t 检验、卡方检验和逻辑回归进行统计检验。
结果
102 例患者中有 35 例（34%）发生 SBBO，16 例（16%）为难治性 SBBO。先天性肠旋转不良（40.0% vs 19.4%，P=0.025）、残留小肠（SB）较短（45.4% vs 66.5%，P=0.004）和患者更不可能从肠外营养（PN）中脱机（51.4% vs 85.1%，P<0.0001）的患者更有可能发生 SBBO。难治性 SBBO 患者更有可能患有先天性肠旋转不良（50.0% vs 22.1%，P=0.020）和残留 SB 较短且大肠残留（23.2% vs 65.9%，P<0.0001 和 60.6% vs 79.4%，P=0.03），且更不可能从 PN 中脱机（37.5% vs 80.2%，P=0.001）。逻辑回归表明，残留 SB 较长是一种保护因素（P=0.001；比值比[OR]，0.95；95%置信区间，0.93-0.99），短肠综合征（SBS）作为 IF 的病因是一个危险因素（P=0.001；OR，0.04；95%置信区间，0.01-0.27）。
结论
残留 SB 较长可预防 SBBO。患有 SBBO 的患者更有可能因 SBS 导致 PIF。
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