Relationship Between Small Intestinal Bacterial Overgrowth And Inflammatory Factors In Patients With Chronic Kidney Disease

Objective: To analyze the occurrence of small intestinal bacterial overgrowth in chronic kidney disease patients and its correlation with inflammatory factor levels,and to explore the relationship between bacterial overgrowth and microinflammation in CKD patients.Methods: We collected forty-four non-dialysis CKD patients(28 men,16 women)and their mean age was(49.84±14.30)years from the department of nephrology in the Second Hospital of Hebei Medical University.All CKD patients were classified into 3 groups according to glomerular filtration rate(units:ml/min/1.73m2)that computed by CKD-EPI formula: CKD 3 stage(30?e GFR<60)12 cases(9men,3 women),CKD 4 stage(15?e GFR<30)16 cases(9 men,7 women)and CKD 5 stage(e GFR<15)16 cases(11 men,5women).Lactulose hydrogen methane breath test was used to detect small intestinal bacterial overgrowth.According to the SIBO results,they were divided into two groups: the SIBO positive group 25 cases(16 men,9 women),the SIBO negative group 19 cases(12 men,7 women).Serum interleukin-6?tumor necrosis factor alpha and hypersensitive C-reactive protein levels were measured by ELISA.To analyze the SIBO positive rate in CKD patients and the relationship between serum inflammatory factors and SIBO.Results:1.The positive rates of SIBO in CKD patients: CKD 3 stage?CKD 4 stage and CKD 5 stage SIBO positive rates were 50.0%,56.3%,and 62.5%.With the decrease of e GFR,the positive rate of SIBO showed an upward trend.2.The serum level of inflammatory factor in CKD patients:The serum level of IL-6 in CKD 5 stage [17.33(8.94)pg/m L] was significantly higher compared to CKD 4 stage[8.69(11.41)pg/m L](P <0.05).The serum level of TNF-?[35.60(68.54)pg/m L]?hs-CRP[99.98(202.53)pg/m L] in CKD 5 stage was significantly higher compared to CKD 3 stage[4.69(18.59)pg/m L]?[36.62(26.64)pg/m L](P <0.05).3.Relationship between SIBO results and inflammatory factor in CKD patients: The serum levels of IL-6[17.60(17.24)pg/m L]?TNF-?[28.62(56.45)pg/m L]?and hs-CRP[109.13(212.37)pg/m L] in SIBO positive group were significantly higher compared to SIBO negative group IL-6[8.43(11.97)pg/m L]?TNF-?[4.29(5.35)pg/m L] and hs-CRP[28.10(23.64)pg/m L](P <0.01).4.SIBO positive rates at different concentrations of inflammatory factors: SIBO positive rates in the high concentration group of IL-6,TNF-?,hs-CRP(72.7%?77.3%?86.4%)was higher than that in the low concentration group(40.9%?36.4%?27.3%)(P<0.05).5.Correlation analysis indicated that the serum levels of IL-6,TNF-?,hs-CRP in CKD patients were negatively correlated with e GFR(P<0.05 or P<0.01),and positively correlated with Scr and Cys C(P<0.05 or P<0.01).Conclusion:1.CKD patients have dysbiosis of intestinal flora,which can be manifested as small intestinal bacterial overgrowth.With the decrease of e GFR in CKD patients,although there was no statistically significant difference in SIBO among the groups,the SIBO positive rate showed a gradual upward trend.2.SIBO positive in CKD patients is closely related to micro-inflammatory status,which may be one of the reasons for participating in the micro-inflammatory status in CKD patients,suggesting that he detection and intervention of SIBO in CKD patients should be paid attention to.