Department of Cardiology Shanghai Institute of Cardiovascular DiseasesZhongshan HospitalFudan University Shanghai China.
Department of Cardiology Zhongshan HospitalFudan University Shanghai China.
J Am Heart Assoc. 2021 Apr 6;10(7):e015292. doi: 10.1161/JAHA.119.015292. Epub 2021 Mar 17.
Background Small intestinal bacterial overgrowth (SIBO) is a common pathological condition of intestinal microbiota. The prevalence of SIBO and its prognostic value in patients with heart failure (HF) are unknown. Methods and Results A total of 287 patients tested for SIBO using lactulose hydrogen-methane breath test were evaluated. At least 1 of the following criteria fulfilled was SIBO positive: patients with fasting hydrogen level ≥20 parts per million (ppm) or a ≥20 ppm rise in hydrogen by 90 minutes were diagnosed with SIBO (H) positive; and patients with methane levels ≥10 ppm at any test point were diagnosed with SIBO (CH) positive. The association between SIBO and the composite of cardiovascular death and HF rehospitalization was investigated. In 287 consecutive patients with HF, 128 (45%) were positive for SIBO. Our result showed SIBO increased the risk of HF rehospitalization in patients with HF with reduced ejection fraction (<0.001), and the risk of cardiovascular death in patients with HF with preserved EF (=0.011). SIBO was an independent risk factor of primary end point in patients with HF (hazard ratio [HR], 2.13; 95% CI; 1.26-3.58; =0.005). In addition, SIBO (CH) showed a prognostic value on adverse outcomes (HR, 2.35; 95% CI, 1.38-4.02; <0.001), whereas the association between SIBO (H) and outcomes was not statistically significant. Conclusions There was high prevalence of SIBO in patients with HF, and SIBO was independently associated with poor outcomes. Proactive treatment for SIBO may provide extra benefit for patients with HF.
小肠细菌过度生长（SIBO）是一种常见的肠道微生物病理状况。SIBO 的患病率及其在心力衰竭（HF）患者中的预后价值尚不清楚。
对 287 例接受乳果糖氢甲烷呼气试验检测 SIBO 的患者进行评估。至少满足以下标准之一被诊断为 SIBO 阳性：空腹氢水平≥20ppm（百万分之一）或 90 分钟内氢水平升高≥20ppm 为 SIBO（H）阳性；任何检测点甲烷水平≥10ppm 为 SIBO（CH）阳性。研究 SIBO 与心血管死亡和 HF 再住院的复合终点之间的关系。在 287 例连续 HF 患者中，128 例（45%）SIBO 阳性。结果表明，在射血分数降低（<0.001）的 HF 患者中，SIBO 增加了 HF 再住院的风险，在射血分数保留的 HF 患者中，SIBO 增加了心血管死亡的风险（=0.011）。SIBO 是 HF 患者主要终点的独立危险因素（风险比[HR]，2.13；95%置信区间；1.26-3.58；=0.005）。此外，SIBO（CH）对不良结局具有预后价值（HR，2.35；95%置信区间，1.38-4.02；<0.001），而 SIBO（H）与结局之间的关联无统计学意义。
HF 患者中 SIBO 的患病率较高，SIBO 与不良结局独立相关。积极治疗 SIBO 可能为 HF 患者带来额外益处。
