小肠细菌过度生长与慢性心力衰竭患者心功能的关系

目的: 探讨小肠细菌过度生长（small intestinal bacterial overgrowth, SIBO)与慢性心力衰竭（chronic heart failure, CHF)患者心力衰竭严重程度的关系。方法: 收集复旦大学附属中山医院心内科收治入院的CHF患者160例，选取同期住院的非CHF患者50例为对照组。通过乳果糖氢呼气试验（lactulose hydrogen breath test, LHBT)检测受试者SIBO情况，比较CHF组与对照组SIBO发生率的差异，并分析CHF患者心力衰竭严重程度（NYHA心功能分级）与SIBO发生率的关系。分析SIBO阳性CHF患者的临床特征，用有序多分类Logistic回归分析CHF患者心衰严重程度的相关因素。结果： ① CHF患者SIBO阳性率(53.8%)较对照组(32.0%)明显升高（x²=7.214,^P＜0.01）；② SIBO在NYHA心功能Ⅰ-Ⅳ级患者中的阳性率分别为20.0%、36.5%、66.7%、71.4%，差异具有统计学意义(x²=16.820，P＜0.01）；③ SIBO阳性组C反应蛋白、N末端B型利钠肽原(NT-proBNP)、肺动脉压(PASP)显著高于SIBO阴性组(均P＜0.05)；SIBO阳性组患者的体征中颈静脉怒张、肺部啰音、下肢水肿的发生率分别为29.1%、24.4%、46.5%，显著高于SIBO阴性组，差异具有统计学意义(均P＜0.05)；④ SIBO阳性与心功能分级加重显著相关（OR=2.661, 95%CI：1.30~5.45, P=0.007）。结论： SIBO阳性是心功能分级加重的相关因素，并且CHF患者SIBO阳性率随心衰严重程度加重而增加。

Association between small intestinal bacterial overgrowth and cardiac function in patients with chronic heart failure

Objective: To investigate the association between small intestinal bacterial overgrowth（SIBO） and the severity of heart failure in chronic heart failure（CHF）patients. Methods: A total of 160 CHF patients admitted to the Department of Cardiology of Zhongshan Hospital were recruited as the CHF group, and 50 non CHF patients admitted in the same period were selected as the control group. Lactulose hydrogen breath test（LHBT）was used to compare the incidence of SIBO between the CHF group and the control group; in addition, the association between the severity of heart failure（NYHA cardiac function classification）and the positivity of SIBO in patients with CHF was also analyzed. The association between SIBO positivity and clinical characteristics of CHF patients was further analyzed, and the ordered multi-categorical Logistic regression was used to screen the factors associated with the severity of heart failure in CHF patients. Results: ① The positive rate of SIBO in patients with CHF（53.8%）was significantly higher than that in the control group（32.0%， x²=7.214，P<0.01). ② The positive rates of SIBO in NYHA cardiac function class Ⅰ-Ⅳ patients were 20.0%, 36.5%, 66.7% and 71.4%, respectively, with statistically significant differences（x²=16.820，P<0.01). ③ C reactive protein, NT-proBNP and pulmonary artery pressure in SIBO positive group were significantly higher than those in SIBO negative group（all P<0.05). The incidences of jugular vein distention, pulmonary rales and lower limb edema in SIBO positive group were 29.1%, 24.4% and 46.5%, respectively, which were significantly higher than those in SIBO negative group（all P<0.05). ④ The positivity of SIBO was significantly associated with the aggravation of cardiac function class（OR=2.661, 95% CI1.30-5.45, P=0.007). Conclusion: The positivity of SIBO is associated with CHF, and the incidence of SIBO in CHF patients increases with the severity of heart failure. ［Key words］chronic heart failure; small intestinal bacterial overgrowth; intestinal flora; NYHA functional classification