空腹呼氢浓度测定作为胰腺外分泌功能不全的一种简便诊断方法。

Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency.

机构信息

Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.

Department of Endoscopy, Nagoya University Hospital, 65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550, Japan.

出版信息

BMC Gastroenterol. 2021 May 10;21(1):211. doi: 10.1186/s12876-021-01776-8.

DOI:10.1186/s12876-021-01776-8

PMID:33971823

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8111728/

Abstract

BACKGROUND

Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. However, there is no method for assessing PEI that can be used noninvasively and easily for outpatient. It has been reported that changes in intestinal bacteria caused by PEI may increase breath hydrogen concentration (BHC) levels during glucose or lactose loading. We have evaluated the usefulness of fasting breath hydrogen concentration (FBHC) measurement without glucose loading for the evaluation of PEI.

METHODS

Sixty patients underwent FBHC measurement, BT-PABA testing, and microbiome analysis. They were classified into PEI group (PABA excretion rate < 73.4%, n = 30) and non-PEI group (n = 30). The FBHC of the two groups were compared, and the diagnostic ability of PEI by them was evaluated. The 16 s rRNA (V3-V4) from fecal samples was analyzed by MiSeq.

RESULTS

FBHC levels was higher in the PEI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001). FBHC was negatively correlated with PABA excretion rate (r = - 0.523, P < 0.001). The cutoff value of FBHC of 10.7 ppm (95% CI: 0.678-0.913, P < 0.001) showed a sensitivity of 73.3% and specificity of 83.3% for PEI diagnosis. In the PEI group, there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05).

CONCLUSION

FBHC shows good potential as a simple and repeatable test for the diagnosis of PEI. The elevated FBHC levels may be caused by hydrogen-producing bacteria such as Clostridium.

摘要

背景

胰腺外分泌功能不全（PEI）与胰腺疾病的预后相关。然而，目前尚无能够用于门诊的非侵入性和简便的 PEI 评估方法。据报道，PEI 引起的肠道细菌变化可能会在葡萄糖或乳糖负荷期间增加呼气氢浓度（BHC）水平。我们已经评估了在不进行葡萄糖负荷的情况下测量空腹呼气氢浓度（FBHC）用于评估 PEI 的实用性。

方法

60 例患者进行了 FBHC 测量、BT-PABA 测试和微生物组分析。他们被分为 PEI 组（PABA 排泄率<73.4%，n=30）和非-PEI 组（n=30）。比较两组的 FBHC，并评估其对 PEI 的诊断能力。通过 MiSeq 分析粪便样本的 16s rRNA（V3-V4）。

结果

PEI 组的 FBHC 水平为 15.70（1.4 至 77.0）ppm，高于非-PEI 组的 2.80（0.7 至 28.2）ppm（P<0.0001）。FBHC 与 PABA 排泄率呈负相关（r=-0.523，P<0.001）。FBHC 的截断值为 10.7ppm（95%CI：0.678-0.913，P<0.001），对 PEI 诊断的灵敏度为 73.3%，特异性为 83.3%。在 PEI 组中，厚壁菌门（Firmicutes）的相对丰度显著增加（P<0.05），梭菌属（Clostridium）的相对丰度也显著增加（P<0.05）。