| Objective:The relationship between intestinal microflora and metabolic diseases,including diabetes,obesity and so on,has attracted much attention.However,previous studies focused more on colonic microflora and Helicobacter pylori(HP)in gastric mucosa,and less on other parts of the gastrointestinal tract,especially the small intestine.The number of bacteria in the small intestine is also closely related to a variety ofmetabolic diseases.The purpose of this study was to evaluate the prevalence of small intestinal bacterial overgrowth(SIBO)and Oro-cecal transit time(OCTT)in patients with type 2 diabetes mellitus(T2DM)by means of lactulose breath test,analyze the relationship between SIBO and diabetic metabolic control and related risk factors,and explore the relationship between SIBO and the occurrence and development of non-alcoholic fatty liver disease(NAFLD),HP infection and other complications.Methods:From August 2015 to August 2019,127 inpatients with T2DM were selected from the digestive department of Tianjin Medical University Chu Hsien-I Memorial Hospical to conduct a cross-sectional study.All the patients underwent lactulosebreath test.According to whether there was bacterial overgrowth in the small intestine,it was divided into two groups:SIBO positive group and SIBO negative group.Theprevalence of SIBO and OCTT were analyzed.The general data,clinical biochemical indexes,islet function and complications of the two groups were compared.The risk factors of SIBO in T2DM patients were analyzed by binary multivariate logisticregression.Result:1.The prevalence of SIBO in T2DM was 43.3%(55/127).2.The area under the expiratory hydrogen curve of positive SIBO group was higher than that of negative group(P<0.05).3.The incidence of delayed OCTT was 74.8%(95/127).The OCTT of SIBO positive group was higher than that of negative group(115.42±19.91min VS.106.11±13.12min,t=2.233,P<0.05).4、The glycosylated hemoglobin(Hb A1c),homeostasis model assessment insulin resistance index(HOMA-IR),homeostasis model assessmentβcell function index(HOMA-β)and insulin sensitivity index(ISI)in the SIBO positive group of T2DM were higher than those in the negative group(t/Z=-3.435-2.159,P<0.05).5、More obese patients with BMI over 28kg/m~2 were found in the positive SIBOgroup than in the negative group(54.5%VS.33.3%,x~2=6.280,P<0.05).The visceral fat area of SIBO positive group was higher than that of negative group(123.80±32.31cm~2VS.95.63±30.01cm~2,t=2.233,P<0.05).The incidence of NAFLD in SIBO positive group was higher than that in negative group(63.6%VS.41.7%,x~2=6.032,P<0.05).The positive group of ALP,GGT,ALT,AST,TBIL and DBIL were higher than the negative group(t=2.322-5.467,P<0.05).There was no significantdifference in IBIL between the two groups.The incidence of NASH in the positive group was higher than that in the negative group(32.7%VS.9.7%,x~2=6.032,P<0.05).6.TSH level in positive SIBO group was higher than that in negative group(t=2.568,P<0.05).There was no significant difference in FT3,FT4 and TPOAb between the two groups.7.Hb and ALB in the positive SIBO group were lower than those in the negative group(t=-2.401-2.698,P<0.05).There was no significant difference in WBC,PLT,Na,K,Cl and CRP between the two groups.The incidence of DPN in the positive group was higher than that of negative group(78.8%VS.56.9%,x~2=5.741,P<0.05).The incidence of osteoporosis was higher than that in the negative group(27.3%VS.12.5%,x~2=4.40,P<0.05).There was no significant difference in the incidence of DR between the two groups.8.The infection rate of HP in the two groups was different,the positive group was higher than the negative group(87.3%VS.61.1%,?~2=10.690,P<0.05).9.The results of multivariate logistic regression analysis indicated that the delay of OCTT(OR=12.941,95%CI:2.738-61.174,P<0.05)and HOMA-IR(OR=1.679,95%CI:1.066-2.645,P<0.05)were independent risk factors for type T2DM with SIBO.Conclusion:1.The prevalence of SIBO in T2DM was 43.3%.2.The level of hydrogen in breath was higher in patients with positive SIBO.3.Insulin resistance was more obvious in T2DM patients with SIBO,and Hb A1c was less well controlled.4.The prevalence of obesity(especially abdominal obesity),NAFLD and DPN was higher in T2DM patients with SIBO.5.The OCTT of T2DM patients with SIBO was more delayed,and they were prone to nutritional absorption disorders,such as the decrease of hemoglobin and serumalbumin,and osteoporosis.6.There was a significant correlation between HP infection and SIBO determined by lactulose hydrogen breath test.7.The independent risk factors of T2DM with SIBO include delayed OCTT and insulin resistance. |
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