Lactose Breath Test in Children
乳糖不耐受症
临床表现的产生取决于乳糖酶
活力低下的严重程度及在小肠上分 布范围的大小, 此外, 结肠对未吸 收乳糖的清除力也是一个影响因素。 LI 还可能由于单糖吸收障碍 (例如 葡萄糖—半乳糖吸收不良)引起, 而 并非乳糖酶本身有缺陷。
1. 测定粪便还原物质和PH: 最简单 的方法是用Ames公司的Clinitest试 剂测定粪便中的还原物质(>0.5%),
呼气氢气升高20ppm为阳性反应(ppm为 百万分密度, 气液色譜仪) 。 如果呼 气氢气高峰在进食乳糖后 1-3 小时 之内出现, 提示小肠内乳糖吸收不良; 如果呼气氢气高峰在进食乳糖后1小时 之内出现, 提示小肠内有细菌过度增 生。
该方法简单, 可靠准确, 灵敏 性及特异性高, 无创伤, 但需一定 设备, LHBT结果有假阴性及假阳性。 当结肠内没有产氢气的菌株, 如用 抗生素治疗或结肠内PH降低等可发 生假阴性。而睡眠状态, 吸烟及进 食纤维素食品可增加氢气的产生出 现假阳性。
2. 口服乳糖耐量试验: 2岁以下小儿禁 食4h, 2岁以上小儿禁食8h后口服乳糖 2g/Kg之后每半小时测血糖共4次, 如 血糖呈低平曲线, 升高不超过20mg/dl, 应考虑低乳糖酶症。但胃排空延迟, 葡萄糖 --半乳糖吸收和代谢异常均可 影响结果。 最重要的是观察口服负荷
量后是否出现腹泻,以及粪便中是否出 现还原物质。
五．治疗： 主要采用限制饮食，即食用不含
乳糖的食物，症状明显改善后，可在 食物中逐渐增加乳糖，以能耐受为度， 多数于36h左右恢复。饮食选择:（1） 无乳糖配方奶，如惠氏的爱儿素，以 豆蛋白为主配制；雀巢的无乳糖奶粉， 安婴乐，奶味较好，但价格高，国产 亦有成品；
（2）乳糖经过预处理的配方，例 如用乳糖酶作用过24h的牛奶;（3）较 贫困家庭可选用谷类或发酵奶与牛奶 混合配方。如有脱水给予相应治疗。 单纯肠炎后LI疗程较短，而伴有慢性 腹泻及营养不良时，疗程较长。当体 重已满意地恢复增长时，即可恢复正 常饮食。
乳糖耐受氢呼吸试验
【名称】乳糖耐受试验和氢呼吸试验【英文名】lactose tolerance test and hydrogen breath test【别名】【概述】乳糖不耐受常见于婴儿，表现为腹泻、吐奶、生长迟滞、吸收障碍。
当给予去乳糖饮食时，患儿临床症状消失。
这种综合征是由于患儿肠道中糖分解酶(乳糖酶)缺乏所引起的。
乳糖耐受试验实际上是利用GTT试验来诊断肠道双糖酶(乳糖酶)缺乏。
测试葡萄糖，观察其在检测个体空腹样本中水平升高或不升高。
氢呼吸试验是检测呼气样本中氢的水平，氢的水平升高是由肠道中乳糖积聚引起的。
结肠细菌代谢乳糖而生成氢气。
【原理】【试剂】【操作方法】实验步骤。
1.遵守GTT操作指示。
2.空腹时抽取血样之后，患者口服200ml含50g乳糖的水溶液(2g乳糖/kg)。
3.间隔O、30min、60min、90min采集血样以备测乳糖水平。
4.血样采集的同时，采集呼气样本以便做氢呼吸试验。
联系实验室，咨询采集标本相关的注意事项。
【正常值】葡萄糖水平从正常值变化为：＞1.7mmol/L(＞30mg/dl)无确定意义：1.1～1.7mmol/L(20～30mg/dl)结果异常：＜1.1mmol/L(＜20mg/dl)氢水平(呼气)。
空腹：＜5ppm或＜5×10-6乳糖消化后：与空腹时水平相比，升高＜12ppm或＜12×10-6【临床意义】1.乳糖不耐受(1)平直的乳糖耐受曲线(即血糖没有升高)意味着糖分解酶缺乏，也见于肠易激综合征。
此种缺陷在美洲印第安人、非裔美国人、亚洲人、犹太人中较普遍。
(2)后续还需进行单糖耐受试验，如葡萄糖/半乳糖耐受试验。
①患者摄入25g的葡萄糖与半乳糖。
②血糖水平正常升高意味着乳糖缺陷。
(3)继发性乳糖缺乏见于：传染性肠炎；肠道细菌过度生长；炎性肠病，Crohn 病；蓝贾第鞭毛虫侵扰；胰腺囊性纤维化。
2.乳糖缺陷测试中氢呼吸试验异常的原因(1)吸收不良使未被消化的乳糖进入结肠后被细菌发酵，生成氢气(H)。
裂隙淋巴细胞协诊婴儿百日咳1例并文献复习
Clinical Journal of Chinese Medicine 2020 V ol.(12) No.35-122-裂隙淋巴细胞协诊婴儿百日咳1例并文献复习One case of fissure lymphocytes in aid-diagnosing infantile pertussis and related literatures review彭 税1 李 俊2 邵丽丽2 杨丽丽2 杨 伟2（1.长治医学院，山西 长治，046000；2.长治市人民医院，山西 长治，046000）中图分类号：R378.4+2 文献标识码：A 文章编号：1674-7860（2020）35-0122- 证型：IAD 【摘 要】目的：探讨裂隙淋巴细胞协诊婴儿百日咳的可能性，为百日咳的诊断提供新思路。
方法：分析1例裂隙淋巴细胞协诊婴儿百日咳的患儿临床资料，并复习相关文献。
结果：患儿甲，男，1个月，咳嗽5天，末梢血涂片发现裂隙淋巴细胞（＞5%），聚合酶链式反应（Polymerase Chain Reaction ，PCR ）技术检出百日咳鲍特菌核酸，诊断为百日咳。
文献复习：近年来，婴儿百日咳发病率呈现逐渐升高的趋势，大部分婴儿百日咳以“支气管炎”或“肺炎”起病，末梢血涂片发现裂隙淋巴细胞可提示临床医务工作者注意有无百日咳（特别是对于分子生物实验室条件受限的医院），预防漏诊或误诊，可及早进行诊治，尽量避免并发症的发生。
结论：婴儿百日咳可通过末梢血涂片发现裂隙淋巴细胞来协诊，临床上可避免误诊或漏诊，减免并发症的发生，保证患儿的正常发育。
【关键词】 婴儿；百日咳；裂隙淋巴细胞【Abstract 】Objective: To explore the possibility of fissure lymphocytes in aid-diagnosing infantile pertussis, and provide a new idea for the diagnosis of pertussis. Methods: The clinical data of 1 case was analyzed and the relevant literatures were reviewed. Results: The patient A, male, 1 month old, coughed for 5 days. Fissure lymphocytes (>5%) were found on the peripheral blood smear. Bordetella pertussis nucleic acid was detected by PCR technology, so pertussis was diagnosed. Literatures review: In recent years, the incidence of infantile pertussis has shown a gradual increase. Most of the infantile pertussis starts with bronchitis or pneumonia. The discovery of fissure lymphocytes in the peripheral blood smear can prompt clinical medical workers to pay attention to the presence or absence of pertussis (especially for hospitals with limited molecular biology laboratory conditions), to prevent missed diagnosis or misdiagnosis, make a diagnosis and give treatment as soon as possible, and try to avoid complications. Conclusion: Infantile pertussis can be aid-diagnosed by finding fissure lymphocytes in peripheral blood smear, to avoid misdiagnosis or missed diagnosis in clinic, reduce complications, and ensure the normal development of children.【Keywords 】Infants; Pertussis; Fissure lymphocyte doi:10.3969/j.issn.1674-7860.2020.35.043百日咳是由百日咳鲍特菌引起的一种高度急性呼吸道传染性疾病，主要通过飞沫传播，人群普遍易感，以未到免疫接种年龄或未完成全程接种的婴幼儿[1]最为高发，其特征性临床症状为阵发性、痉挛性咳嗽，咳嗽终末出现深长的“鸡鸣”样吸气性吼声，夜间为著，咳嗽虽重而肺部多无明显异常体征（症状与体征不符），咽拭子及痰培养百日咳鲍特菌阳性可确诊。
慢性肝炎患者乳果糖氢呼气试验结果分析
慢性肝炎患者乳果糖氢呼气试验结果分析作者：刘伟，钟良，钟基大，戎兰，徐章【关键词】慢性乙型肝炎；乳果糖氢呼气试验；小肠细菌过度生长【摘要】目的分析38例慢性乙肝患者的乳果糖氢呼气试验结果，了解慢性乙肝患者小肠细菌过度生长(small intestinal bacterial overgrowth，SIBO) 情况。
方法对38例慢性乙型病毒性肝炎患者及40例正常人以10g乳果糖为基质做氢呼气试验（lactulose hydrogen breath test，LHBT）。
结果 38例慢性肝炎患者中LHBT阳性者12例（31.6％），提示这部分患者存在小肠细菌过度生长，40例正常对照者中无LHBT阳性者；伴小肠细菌过度生长的慢性肝炎患者在服用相同基质的条件下，其在单位时间内产氢量、峰值明显高于或峰值时间明显早于无小肠细菌过度生长者。
结论部分慢性肝炎患者LHBT阳性，提示存在小肠细菌过度生长；乳果糖氢呼气试验检测小肠细菌过度生长具有快速，较准确、患者易于接受等特点，基质易得，易于在临床上应用。
【关键词】慢性乙型肝炎；乳果糖氢呼气试验；小肠细菌过度生长氢呼气试验（hydrogen breath test，HBT）所用基质多为糖类物质，如乳果糖、葡萄糖、乳糖等，当存在小肠细菌过度生长时，口服的糖类物质在进入结肠之前，即被过度生长的细菌发酵产生氢气，故此时测定呼气中氢水平和氢浓度增高的时间可检测小肠内细菌过度生长［1］。
乳果糖为不吸收的糖类物质，可以反映整个小肠的情况，本研究采用乳果糖氢呼吸试验(LHBT)检测慢性肝炎和正常人的小肠细菌过度生长情况。
1 资料与方法1.1 受试者情况符合入选标准的慢性乙型肝炎38例，男28例，女10例，年龄20～74岁，平均（43.1±13.6）岁，其中轻度17例，中度11例，重度10例；LHBT阳性12例，其中肝炎轻度2例，中度4例，重度6例。
正常对照组40例，男24例，女16例，年龄25～67岁，平均（44.3±10.8）岁，无LHBT 阳性者。
新生儿呼吸窘迫综合症-2013欧洲共识
败血症预防性治疗
１）呼吸窘迫综合症新生儿往往一开始就应用抗生素直到败血 症被排除，应减少应用范围和减少不必要的暴露；常用的方案 包括青霉素和氨苄青霉素结合一个氨基糖苷类抗生素(D)；一旦 排除败血症就尽快停止应用抗生素； ２）在有很高侵袭性真菌感染风险的监护室，对于出生体重 <1,000 g或胎龄 ≤27 周的新生儿可预防性应用氟康唑；从生后第 一天开始，３mg/kg 每周２次用６周（A）。
产前管理
1) 有早产风险的产妇应该转移到具有早产儿管呼吸窘迫综合症 管理经验的医疗机构(C)。 2)对胎龄23周到34周的妊娠有早产风险的所有孕妇应产前予糖 皮质激素1次(A)。 3)首剂糖皮质激素超过2-3周及胎龄<33周有其他产科指标，应用 第二剂糖皮质激素是合适的(A)。 4)对接受剖宫产孕妇在足月分娩前可考虑产前类固醇应用(B)。 5)对于有胎膜早破的母亲应用抗生素可以用于可以减少早产的 风险(A)。 6)短期应用抗宫缩药可以使产前糖皮质激素发挥作用和或起到 宫内转运到围产医学中心（B）。
其他注意事项
1）在３９周之前对低风险妊娠不应该行选择性剖腹产（B）。 2)吸入一氧化氮疗法对早产儿呼吸窘迫综合症管理无益(A)。 3)肺表面活性物质可以改善肺出血后氧状态,但可能无长远好处 (C)。 4)用肺表面活性物质替代改善ＢＰＤ只能有短期好处，,不推荐 使用(C)。
肺表面活性物质应用
１）呼吸窘迫新生儿需应用天然肺表面活性物质（A）； ２）预防性应用肺表面活性物质应该是标准化的，但也有特 殊情况，例如母亲未产前应用激素的极早产儿或需气管插管 复苏稳定的（A）； ３）呼吸窘迫综合新生儿需尽早的应用肺表面活性物质；推 荐方案是，胎龄<26周，吸入氧浓度>0.3时或胎龄>26周，吸 入氧浓度>0.4时（B）； 4）对呼吸窘迫综合症的治疗固尔苏的初始剂量200mg/kg比 100mg/kg疗效好（A）； 5）采用INSURE技术；较成熟的新生儿应用肺表面活性物质 后立即拔管后应用CPAP或NIPPV；同时临床要根据患儿是否 耐受进行调节方案（B）。 6）如需持续用氧或需要机械通气进行加重的呼吸窘迫综合 症，需应用第二剂及第三剂肺表面活性物质。
Prepare
Regional LaboratoryHYDROGEN BREATH TESTSLACTOSE INTOLERANCE AND BACTERIAL OVERGROWTHPATIENT PREPARATION, PRECONDITIONS,AND COLLECTION PROCEDURESSCHEDULING:The Lactose intolerance and Bacterial overgrowth hydrogen breath tests must be scheduled in advance. Please call (616) 267-2660 to schedule these tests. The Butterworth Hospital Outpatient Laboratory location is the only Spectrum Health site that routinely collects specimens for the hydrogen breath tests. The test is available Monday through Friday with two appointments daily, each lasting up to three hours. PATIENT PREPARATIONS INSTRUCTIONS AND PRECONDITIONS:Only a properly prepared patient should have a hydrogen breath test performed. Incorrectly prepared patients may have conditions present that can affect the outcome of the test. Therefore the following instructions should be followed before testing:1. The patient should be instructed not to eat bran, high fiber cereals or other hard to digest foods likebeans the day before the test.2. The patient should fast for 12 hours prior to the test, with only water to drink.3. The patient should not smoke for at least one hour prior to or during the test.4. The patient should not vigorously exercise, smoke, or sleep for at least one hour prior to testing orduring the test.5. Ask the patient about any recent antibiotic therapy. Antibiotics SHOULD NOT be prescribed for atleast two weeks before testing.SPECIMEN COLLECTION:Improper specimen collection can adversely affect the outcome of the test. Specimen collection should only be performed by staff with experience in proper specimen collection procedures.Hydrogen Breath Test 1。
儿科指南目录(英文)
1.European Consensus Guidelines on the Management of Respiratory DistressSyndrome - 2016 Update.EAPM欧洲指南共识：呼吸窘迫综合征的管理（2016更新版）2.Management of undescended testes: European Association of Urology/EuropeanSociety for Paediatric Urology Guidelines. EAU/ESPU指南：隐睾症的管理（2016）3.Recommendations for Prevention and control of influenza in children,2016-2017.AAP儿童流感的预防与控制建议（2016~2017）4.ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment ofGastrointestinal and Nutritional Complications in Children with EsophagealAtresia- Tracheoesophageal Fistula. SPGHAN/NASPGHAN指南：儿童食管闭锁,气管食管瘘胃肠道和营养并发症的评估和治疗（2016）5.Prevention of food and airway allergy: consensus of the Italian Society ofPreventive and Social Paediatrics, the Italian Society of Paediatric Allergy andImmunology, and Italian Society of Pediatrics.意大利儿童食物和呼吸道过敏预防共识（2016）6.Official American Thoracic Society Clinical Practice Guidelines DiagnosticEvaluation of Infants with Recurrent or Persistent Wheezing. ATS临床实践指南：婴儿复发性或持续性喘息的诊断评估（2016）7.ACR Appropriateness Criteria Fever Without Source or Unknown Origin-Child. ACR适宜性标准：儿童无源性或不明原因发热（2016）8.2016 European Society of Hypertension guidelines for the management of highblood pressure in children and adolescents. ESH指南：儿童青少年高血压的管理（2016）9.2016 European Society of Hypertension guidelines for the management of highblood pressure in children and adolescents. NASPGHAN/ESPGHAN联合建议：婴幼儿胆汁淤积性黄疸的评估指南（2016）10.Recommendations for neonatologist performed echocardiography in EuropeConsensus Statement endorsed by European Society for Paediatric Research(ESPR) and European Society for Neonatology (ESN). ESPR/ESN共识声明：新生儿超声心动图检查建议（2016）11.Clinical recommendations for pain, sedation, withdrawal and delirium assessmentin critically ill infants and children an ESPNIC position statement for healthcare professionals. ESPNIC立场声明：危重婴幼儿和儿童疼痛，镇静，戒断和精神状态评估建议（2016）12.International Pediatric Otolaryngology Group (IPOG) consensus recommendations:Routine peri-operative pediatric tracheotomy care. IPOG共识建议：常规术前小儿气管切开管理（2016）13.Prevention of Vitamin K deficiency bleeding in newborn infants a position paperby the ESPGHAN Committee on Nutrition. ESPGHAN意见书：预防新生儿维生素K 缺乏性出血（2016）14.Daily iron supplementation in infants and children Guideline. WHO指南：婴儿和儿童每日铁补充（2016）15.Guideline for the Treatment of Breakthrough and the Prevention of RefractoryChemotherapy-Induced Nausea and Vomiting in Children With Cancer. POGO指南：儿童肿瘤患者顽固性化疗引起的恶心呕吐突破性治疗和预防（2016）16.Experts' recommendations for the management of cardiogenic shock in children.儿童心源性休克管理专家建议（2016）17.NICE：Intravenous fluid therapy in children and young people in hospital. NICE指南：住院儿童和青年人静脉补液治疗18.Recommendations for the prevention and treatment of haemolytic disease of thefoetus and newborn.胎儿和新生儿溶血性疾病的预防和治疗建议19.Recommendations from the Pediatric Endocrine Society for Evaluation andManagement of Persistent Hypoglycemia in Neonates, Infants, and Children. PES 推荐建议：新生儿，婴儿以及儿童持续性低血糖的评估和管理20.CSACI position statement: systemic effect of inhaled corticosteroids on adrenalsuppression in the management of pediatric asthma. CSACI共识声明：小儿哮喘管理吸入糖皮质激素对肾上腺皮质抑制的全身毒性作用21.NICE clinical guideline：Bronchiolitis in children. NICE临床指南：儿童毛细支气管炎22.Practice Guideline: Epistaxis in Children.儿童鼻出血实践指南23.Summary of recommendations for the management of infantile seizures: TaskForce Report for the ILAE Commission of Pediatrics. ILAE儿科专家组报告：小儿癫痫的管理建议（摘要）24.Finnish guidelines for the treatment of laryngitis, wheezing bronchitis andbronchiolitis in children.芬兰儿童喉炎、哮喘支气管炎和毛细支气管炎的治疗指南25.KHA-CARI guideline: Diagnosis and treatment of urinary tract infection in children.KHA-CARI指南：儿童尿路感染的诊断和治疗26.Recommendations for transfusion therapy in neonatology.新生儿输血治疗建议27.Managing possible serious bacterial infection in young infants when referral is notfeasible. WHO指南：婴儿潜在严重细菌感染的管理28.Practice parameter for the diagnosis and management of primaryimmunodeficiency.原发性免疫缺陷的诊断和管理指南29.Finnish guidelines for the treatment of community-acquired pneumonia andpertussis in children. FMSD指南：芬兰儿童社区获得性肺炎和百日咳的治疗mittee Opinion No. 644: The Apgar Score. ACOG/AAP委员会意见：阿普伽新生儿评分（No.644）31.Global Consensus Recommendations on Prevention and Management ofNutritional Rickets.全球共识建议：营养性佝偻病的预防和管理（2016）32.The prevention of early-onset neonatal group B streptococcus infection: NewZealand Consensus Guidelines 2014.新西兰共识指南：早发型新生儿B组链球菌感染的预防33.Queensland Clinical Guideline: Hypoxic-ischaemic encephalopathy (HIE). 昆士兰临床指南：缺血缺氧性脑病（HIE）（2016）34.ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools andchildcare: 2015 update. ASCIA指南：学龄，学龄前儿童过敏性反应的预防（更新版）35.Guidelines for Feeding Very Low Birth Weight Infants. 极低出生体重婴儿喂养指南。
13c呼气试验检测流程
13c呼气试验检测流程English Answer：13C Breath Test Protocol.The 13C breath test is a non-invasive medical test used to diagnose certain conditions, such as lactose intolerance, small intestinal bacterial overgrowth (SIBO), and Helicobacter pylori infection. The test involves ingestinga small amount of a sugar solution that contains a stable isotope of carbon (13C). The 13C is then absorbed into the bloodstream and travels to the small intestine, where it is broken down by bacteria. The bacteria produce carbondioxide (CO2) as a byproduct, which is then exhaled. The amount of 13C in the exhaled CO2 can be measured to determine the presence and severity of certain conditions.Procedure:1. Preparation: The patient should fast for 12 hoursprior to the test.2. Ingestion: The patient will be given a drink that contains the 13C-labeled sugar solution.3. Collection: The patient will be asked to blow into a breath collection bag at regular intervals (usually every 30 minutes) for 2-4 hours.4. Analysis: The breath samples will be analyzed for the presence of 13C in the exhaled CO2.Interpretation:The results of the 13C breath test can be used to:Diagnose lactose intolerance: If the patient has lactose intolerance, the bacteria in their small intestine will produce excessive amounts of CO2 after ingesting the lactose solution.Diagnose SIBO: If the patient has SIBO, the bacteriain their small intestine will produce excessive amounts of CO2 even in the absence of lactose.Diagnose Helicobacter pylori infection: If the patient has H. pylori infection, the bacteria will produce an enzyme that breaks down the 13C-labeled sugar solution, resulting in a lower amount of 13C in the exhaled CO2.Limitations:The 13C breath test is not always 100% accurate. The test may be affected by factors such as:Recent antibiotic use.Gastric emptying time.Bacterial colonization of the stomach.中文回答：13C呼气试验检测流程。
Lactose Intolerance
Lactose IntoleranceWhat is lactose intolerance?Lactose intolerance is when your body can’t break down or digest lactose. Lactose is a sugar found in milk and milk products.Lactose intolerance happens when your small intestine does not make enough of adigestive enzyme called lactase. Lactase breaks down the lactose in food so your body can absorb it. People who are lactose intolerant have unpleasant symptoms after eating or drinking milk or milk products. These symptoms include bloating, diarrhea, and gas.Lactose intolerance is not the same thing as having a food allergy to milk.Lactose intolerance is most common in Asian Americans, African Americans, MexicanAmericans, and Native Americans.What causes lactose intolerance?Both children and adults can get lactose intolerance. Here are some common causes of this condition:∙Lactose intolerance often runs in families (hereditary). In these cases, over time a person’s body may make less of the lactase enzyme. Symptoms may occur during the teen or adult years.∙In some cases, the small intestine stops making lactase after an injury or after a disease or infection.∙Some babies born too early (premature babies) may not be able to make enough lactase. This is often a short-term problem that goes away.∙In very rare cases some newborns can’t make any lactase from birth.What are the symptoms of lactose intolerance?Each person’s symptoms may vary. Symptoms often start about 30 minutes to 2 hours after you have food or drinks that have lactose.Symptoms may include:∙Belly (abdominal) cramps and pain∙Nausea∙Bloating∙Gas∙DiarrheaHow severe your symptoms are will depend on how much lactose you have had. It will also depend on how much lactase your body makes.The symptoms of lactose intolerance may look like other health problems. Always see your healthcare provider to be sure.How is lactose intolerance diagnosed?Your healthcare provider will talk to you about your past health and family history. He or she will give you a physical exam.You may be asked not to have any milk or milk products for a short time to see if your symptoms get better.You may also have some tests to check for lactose intolerance. These may include:∙Lactose tolerance test. This test checks how your digestive system absorbs lactose. You will be asked not to eat or drink anything for about 8 hours before the test. This often means not eating after midnight. For the test, you will drink a liquid that has lactose. Some blood samples will be taken over a 2-hour period. These will check your blood sugar (blood glucose) level. If your blood sugar levels don’t rise, you may be lactose intolerant.∙Hydrogen breath test. You will drink a liquid that has a lot of lactose. Your breath will be checked several times. High levels of hydrogen in your breath may mean you are lactoseintolerant.∙Stool acidity test. This test is used for infants and young children. It checks how much acid is in the stool. If someone is not digesting lactose, their stool will have lactic acid, glucose, and other fatty acids.How is lactose intolerance treated?There is no treatment that can help your body make more lactase. But you can manage your symptoms by changing your diet.In the past, people who were lactose intolerant were told to stop taking dairy products.Today, health experts suggest you try different dairy foods and see which ones cause fewer symptoms. That way you can still get enough calcium and other important nutrients.Lactose intolerance symptoms can be unpleasant, but they won’t hurt you. So try to find dai ry foods that don’t cause severe symptoms.Here are some tips for managing lactose in your diet:∙Start slowly. Try adding small amounts of milk or milk products and see how your body reacts.∙Have milk and milk products with other foods. You may find you have fewer symptoms if you take milk or milk products with your meals. Try eating cheese with crackers or having milk with cereal.∙Eat dairy products with naturally lower levels of lactose. These include hard cheeses and yogurt.∙Look for lactose-free and lactose-reduced milk and milk products. These can be found at many food stores. They are the same as regular milk and milk products. But they have the lactase enzyme added to them.∙Ask about lactase products. Ask your healthcare provider if you should take a lactase pill or lactase drops when you eat or drink milk products.If you have trouble finding dairy products that don’t cause symptoms, talk to yourhealthcare provider. He or she can suggest other foods to be sure you get enough calcium.You may need to take calcium supplements.Children with lactose intolerance should be seen by a healthcare provider. Children and teenagers need dairy foods. They are a major source of calcium for bone growth and health.They also have other nutrients that children need for growth.Living with lactose intoleranceLactose intolerance can affect you every time you eat a snack or meal. So you need to be careful about the foods you eat every day. However many people can tolerate a certain amount of lactose and don't need to completely avoid it.It’s important to read food labels. Lactose is often added to some boxed, canned, frozen, and prepared foods such as:∙Bread∙Cereal∙Lunch meats∙Salad dressings∙Cake and cookie mixes∙Coffee creamersCheck food labels for words that may mean a food has lactose in it, such as:∙Butter∙Cheese∙Cream∙Dried milk∙Milk solids∙Powdered milk∙WheyWhen should I call my healthcare provider?Call your healthcare provider if you have trouble managing your symptoms. Somesymptoms can be embarrassing. Your healthcare provider can work with you to help keep them under control.Key points∙Lactose intolerance is when your body can’t break down or digest lactose. Lactose is a sugar found in milk and milk products.∙It happens when you don’t have enough of an enzyme called lactase. Lactase breaks down lactose in food.∙The most common symptoms of lactose intolerance are belly cramps and pain, nausea, bloating, gas, and diarrhea.∙There is no treatment that can help your body make more lactase.∙You can manage your symptoms by changing your diet.Next stepsTips to help you get the most from a visit to your healthcare provider:∙Know the reason for your visit and what you want to happen.∙Before your visit, write down questions you want answered.∙Bring someone with you to help you ask questions and remember what your provider tells you. ∙At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests.Also write down any new instructions your provider gives you.∙Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.∙Ask if your condition can be treated in other ways.∙Know why a test or procedure is recommended and what the results could mean.∙Know what to expect if you do not take the medicine or have the test or procedure.∙If you have a follow-up appointment, write down the date, time, and purpose for that visit.∙Know how you can contact your provider if you have questions.。
瑞芬太尼-异丙酚合剂微泵法行小儿静脉全麻
瑞芬太尼-异丙酚合剂微泵法行小儿静脉全麻中的应用宝坻医院麻醉科高顺利张守林高斌摘要：目的比较瑞芬太尼和芬太尼配伍异丙酚全身麻醉中应用。
方法选择60例小儿全麻病人，随机分为A、B两组，每组各30例，术中监测MAP、HR、ECG、SPO2、ETCO2，麻醉诱导两组均静脉给予咪唑安定0.2mg/kg，异丙酚2.5mg/kg，维库溴铵0.1mg/kg，两组持续泵入异丙酚3~6mg/kg/h,维库溴铵0.08mg/kg/h，A组给予瑞芬太尼1μg/kg，B组给予芬太尼3μg/kg,A组持续静脉泵注瑞芬太尼15μg./kg/h，B组持续静脉泵入芬太尼1.8μg/kg/h。
术毕前10min停用维库溴铵,术毕停用麻醉药。
记录患儿诱导前、诱导后1min、插管后2.5min的血流动力学变化,连续观察MAP、HR、ECG、SPO2、ETCO2、术毕停药至清醒时间、停药至拔管时间、苏醒期呼吸抑制、喉痉挛等并发症及。
结果麻醉时间A组(126±16.5)min，组(128±13.5)min，两组差异无统计学意义(P>0.05)。
诱导后1min，A、B两组的MAP、HR均下降(P<0.01)，但在正常范围；插管后2.5min与诱导后1min比较，A组的MAP、HR变化不大(P>0.05)，B组变化较大(P<0.01)，停药后清醒时间、拔管时间A组短于B组(P<0.01)，苏醒期呼吸道梗阻或屏气、SPO2降低A组低于B组(P<0.05)，但躁动发生率A组高于B组(P<0.05)。
结论瑞芬太尼比芬太尼能更有效抑制气管插管时的心血管反应，且术后苏醒迅速，低氧的发生率低。
关键词瑞芬太尼芬太尼静脉全麻小儿Remifentanil-propofol combined application with micro-pump method in children intravenousanesthesiaGao Shun-li,Zhang Shou-lin,Gao Bin(Department of Anesthesiology Baodi Hospital)【Abstract】Objective To compare remifentanil and fentanylcombined with propofol is applied in childrenintravenous anaesthesia.Methods60 children undergoing defferentopperation with intravenous anesthesia except were divided intotwo groups randomly with 30 cases each.MAP、HR、ECG、SPO2 and ETCO2were recorded ,both groups were administrated with midazolam 0.2mg/kg,remifentanil 1μg/kg was given in group A,and fentanyl3μg/kg in group B,which was followed by propofol 2.5mg/kg and vecuronium 0.1mg/kg,and then the trachea was intubated. And then propofol 3~6mg/kg/h and vecuronium 0.08mg/kg/h were continued administrated by micro-pump.Group A continue administrated remifentanil 15μg./kg/h ,GroupB was fentanyl 1.8μg./kg/h. Vecuronium was stoped at 10min before operation completed and propofol was finished when operation completed.MAP、HR、ECG、SPO2 and ETCO2 was recorded before drug administration,at 1 min after that,2.5 min after intubation.And recorder time from finish drug until sober and from finish drug to extubation.Recordering breath restrained 、throat spasmand and adverse reactions in period of revival.Results anesthesia time groupA(126±16.5)min，groupB(128±13.5)min，there was no significant difference between two groups, MAP、HR were descend but no excess normal confine at 1min after drug administration;MAP、HR of GroupA had no significant different compare 2.5min after intubation to 1min after drug administration(P>0.05),groupB had a greatrise(P<0.01);The rate of respiratory obstruct and SPO2 droping was fewwer in group A than B.Conclusions Remifentanil can more effective control cardiovascular reaction at trachea was intubated,and reduce the rate of hypoxia . Patient rapider revival.【Key words】Remifentanil,Fentanyl,Intravenousanaesthesia ,ChildrenFentanyl is normal analgesic grug,has strong analgesic effect, be widly used in children anaesthesia,but it has long restrain breath so it was carefully applied in childrenanesthesia.Remifentanil is new artificial ultra-short effect opiates drug,it is hydroiyzed by non-spcific,and has some merit such as no organ-dependent,completely and quickly metaboliz and good controllability.This research would find the effection of remifentanil-propofol on children blood kinetic and complications when it had been continue micro-pumped.1 Data and means1.1 Commonly data ASAⅠ~Ⅱlevel children 60 cases,age 2~10 year,weight 9~25kg ,operation kinds:tonsil hypertrophy、adenoid hyperplasia 38 cases,congenital hypertrophic pyloric obstruction 5 cases,limb surgery 17 cases.Operation time 1~6 h.Both groups have no significant different on sex、year and weight.1.2 Anaesthesia methods Patients were injected atropin0.01mg/kg at 30min before operation,set up veindypass,multi-function monitor non-invasive monitoring MAP、HR、ECG、SPO2、ETCO2. Both groups were administrated with midazolam 0.2mg/kg,remifentanil 1μg/kg was given in group A,and fentanyl 3μg/kg in group B,which was followed by propofol 2.5mg/kg and vecuronium 0.1mg/kg,oxygen was provided through pressurized oxygen mask.Endotracheal intubation and then mechanical ventilation after muscle relaxed .Maintaininganaesthesia:propofol 3~6mg/kg/h and vecuronium 0.08mg/kg/h were continued administrated by micro-pump.Group A continue administrated remifentanil 15μg./kg/h ,GroupB was fentanyl1.8μg./kg/h. Vecuronium was stoped at 10min before operation completed and propofol was finished when operation completed.1.3 Observe index Index of hemodynamic changes ,such as MAP、HR、 ECG、 SPO2、 ETCO2, were recorded on before drug administration and 1 min after that, after intubation2.5min.Recording time from finish drug until sober and from finish drug to extubation.Observing adverse reactions and complications, respiratory depression 、throat spasmand ,in period come round.1.4 S tatistics manage All datas were statistic analyzed applying software package SPSS11.5.All results were expressed through x 土s,data between in groups were compared by both groups independent samples t test,repeated measures datas were compared with analysis of variance,chi-square test disposed comparision of count datas,P<0.05 shows that result has statistical significance.2 Result2.1 Anaesthesia time A group (126±16.5)min，B组(128±13.5)min，deferrence between both groups has no statistical significance (P>0.05).2.2 C hange of hemodynamics MAP、HR in both groups descended on 1 min after drug administration (P>0.05),but it was not exceed the normal range;MAP、HR at 2.5 min after intubation had little change relative to 1 min after administration in group A,it hada significant rise (P<0.01), show chart 1.2.3Situation after operation Time of come round and extubation after finish drug was shorter in group A than B(P<0.01),chart 2.Airway obstruction or breath-hold、hypoxia was fewwer in group A,but the rate of restlessness was higher (P<0.05),chart3.3 ConclusionPropofol,a new faster via vein anaesthesia drug,has some characteristics that it 异丙酚作为新型速效静脉麻醉药，具有起效迅速、体内消除快、恢复迅速完全的特点，目前广泛的应用于麻醉诱导和维持。
methane-breath-testing
Glucose Hydrogen/Methane Breath TestingEndoscopy SuitePatient InformationWhat is a breath test?A glucose hydrogen breath test is used to make several diagnoses including lactose intolerance, carbohydrate malabsorption and small bowel bacterial overgrowth.After giving you a sugary-tasting drink, we will ask you to blow (exhale) into a small bag and measure the gases in your breath every 20 minutes until the test has been completed. Please allow 3 hours to be at the hospital.Why am I having a breath test?If the working of your digestive tract has been changed by surgery, chemotherapy, radiotherapy or other conditions, you may have symptoms such as watery loose stool, a need to rush to the lavatory, wind and bloating.If certain gases (hydrogen and methane) in your breath are abnormally high, it will help us to establish whether your symptoms are due to specifi c foods in your diet or whether you have germs in the small bowel where there should not be any.In small bowel bacterial overgrowth, the test is used to try and detect the presence of germs in the small bowel.What preparation will I need for my breath test?You will be asked to change your diet (as outlined in this leafl et) so that any breath test measurements recorded are accurate.It is important that you follow the instructions below very carefully. If these are not followed, your procedure may have to be cancelled.If any of the following apply to you, please contact the endoscopy suite a few days prior to your appointment (contact details on last page):•You have any concerns/queries•You have diabetesYou are taking chemotherapy drugs••You are taking anti-epileptic drugs•You are taking a medication which is taken daily at a set time You are due to undergo a gastroscopy and/or colonoscopy on •the same day as the breath test procedure24 hours before the testFoods from the following list are allowed to be eaten and does not infl uence the test result:•Red meat•Fish eg. white fi sh, shellfi sh, tuna, salmon,•Chicken•Tofu, QuornEggs – scrambled, boiled, fried, poached••Cheese – all typesMilk, natural yoghurt, ice cream••White: bread / rolls / croissants / chapattis/ rotis / naan /pitta bread / pastry•White pasta or rice•Rice crispies, cornfl akes, congee•Rich tea biscuits/other plain biscuits•Oil, butter, margarine, ghee•Potato (no skin) eg. boiled, mashed, roast, crisps•Tea/Coff ee with a splash of milk & no sugar. Herbal tea. •Salt / pepper / herbs / spices / marmite / mayonnaise /mustard / salad dressing•Sugar free chewing gumThe following food does infl uence the test result and should NOT be consumed for 24 hours before the test:•Canned drinks, carbonated drinks & fruit juices•Alcohol•Fruit (including fresh, tinned, stewed, dried, or preserved)•ALL vegetables except potatoes (no skin)•Sweets, chocolateSugar••Marmalade, jam, honey, chocolate spread, peanut butter •Tomato Ketchup, brown sauce, pickle, chutney, chilli sauce •Wholegrain cereals eg. weetabix, all bran, bran fl akes,muesli•Brown rice or pastaWholemeal: bread / rolls / chapattis/ rotis / naan••Lentils, pulses•Nuts12 hours before the test:•Please do not eat or drink anything except water for 12 hours before the test ie. if your test is at 8am, stop eating anddrinking after 8pm on the previous night.You are allowed to drink water at any time.••Take your evening medications as usual.On the morning of your test•Please clean your teeth. Avoid mouthwash unless it issugar free. Sugar free mouthwash will be provided at theendoscopy suite.•Unless told otherwise, DO NOT take your usual medication (as it may be sugar coated) before the test, however do bring ALL your usual medication with you to the hospital so you can take it after completion of the test.•Do not smoke for an hour before the test or during the test as it raises your hydrogen levels and causes a false positive result.What will happen when I come up for the breath test?•You will be asked to complete a questionnaire about yoursymptoms.•You will be asked to blow (exhale) into a bag for a baseline measurement.You will be given a small sweet liquid to drink.••You will then be asked to blow (exhale) in to a bag at specifi c times until the test is completed.•You will be asked to write down any bowel symptoms you experience during the test.What happens afterwards?You may eat and drink as normal. You will be given a drink and a sandwich following the procedure and can take your usual medications.When will I know the results?The results will be sent to your GP and the consultant who referred you for the test. A follow up appointment will be arranged if required.Endoscopy Suite Contact DetailsThe working times of the Endoscopy Suite are 08.00 - 17.00 Monday to Friday: 0207 811 8328. If your call is unanswered, you can leave an answerphone message. Answerphone messages will be checked twice daily (Monday – Friday) and a member of the Endoscopy Suite will return your call as soon as possible.Outside of working hours, you can ring the main switchboard number: 0207 352 8171 and ask to speak to the Clinical Site Practitioner (bleep 022) at Chelsea.If you would like this information sheet in a diff erent format, please contact the PALs offi ce on 0800 783 7176 or talk to the clinical staff responsible for your care.ReferencesThis booklet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this booklet are available on request from:The Royal Marsden Help CentreFreephone: 0800 783 7176Email: patientcentre@No confl icts of interest were declared in the production of this bookletPublished October 2012. Planned review October 2014© The Royal Marsden NHS Foundation Trust EU-1331-01Life demands excellenceRadiotherapy andChemotherapy ServicesF538021 & F538022。
消化内科吹气检查流程
消化内科吹气检查流程英文回答：The process of a breath test in the field of gastroenterology involves several steps. Firstly, the patient is asked to refrain from eating or drinking anything for a certain period of time before the test. This is usually done to ensure accurate results. Then, the patient is given a substance to ingest, such as lactose or glucose, which will be metabolized by the bacteria in the gut. After ingesting the substance, the patient is required to blow into a tube or a bag at regular intervals. The breath samples are then analyzed to measure the levels of certain gases, such as hydrogen or methane, which can indicate the presence of certain conditions, such as lactose intolerance or bacterial overgrowth.During the test, the patient may experience some discomfort or bloating due to the ingestion of the substance. However, it is generally a safe and non-invasiveprocedure. The results of the breath test can provide valuable information for the diagnosis and treatment of various gastrointestinal disorders.For example, let's say I am a patient who suspects that I may have lactose intolerance. I would visit a gastroenterologist who specializes in digestive disorders. The doctor would explain the breath test procedure to me and ask me to follow the fasting instructions before the test. On the day of the test, I would go to the doctor's office and be given a lactose solution to drink. Then, I would be provided with a breathalyzer device and instructed to blow into it at regular intervals, such as every 15 minutes, for a certain duration. After the test, the doctor would analyze the breath samples and discuss the results with me. If the test indicates that I have high levels of hydrogen or methane, it may suggest that I have lactose intolerance.中文回答：消化内科吹气检查流程包括几个步骤。
氢呼气试验文献整理
2、小肠菌群过度生长：
1）IBS，正常与IBS对照组进行氢呼气试验，IBS组氢呼气增多，但小肠菌群过度生长是否是IBS的病因仍具争议。
????【11】Ford?AC,?Spiegel?BM,?Talley?NJ,?Moayyedi?P.?Small?intestinal?bacterial?overgrowth?in?irritable?bowel?syndrome:?systematic?review?and?meta-analysis.?Clin?Gastroenterol?Hepatol.?2009?Dec;7(12):1279-86.?Epub?2009?Aug?12.?Review.?PubMed?PMID:?19602448.?IBS中小肠菌群过度生长：荟萃分析。
Fridge?JL,?Conrad?C,?Gerson?L,et?al.?Risk?factors?for?small?bowel?bacterial?overgrowth?in?cystic?fibrosis.?J?Pediatr?Gastroenterol?Nutr.?2007?Feb;44(2):212-8.?PubMed?PMID:?17255834.胆囊纤维化患者小肠菌群过度生长的风险因素。
2）小肠菌群过度生长与药物
????【12】Lombardo?L,?Foti?M,?Ruggia?O,?Chiecchio?A.?Increased?incidence?of?small?intestinal?bacterial?overgrowth?during?proton?pump?inhibitor?therapy.?Clin?Gastroenterol?Hepatol.?2010?Jun;8(6):504-8.?Epub?2010?Jan?6.?PubMed?PMID:20060064.PPI治疗期间小肠菌群过度生长发病率增加。
How to test for lactose intolerance in infants
Lactose Intolerant InfantsWhat are the alternatives for lactose intolerance infants?(October 14, 2011)For infants who suffer from lactose intolerance some of the possible alternatives could be almond milk, hemp milk and coconut milk. In the case of these milks it is best to first ensure that your child does not have an allergy to nuts as this could cause other complications. Breastfeeding mothers can also try pumping breast milk and treating it with lactase enzyme if their babies are lactose intolerant. There are also a number of milk free infant formulas which can be given to babies who suffer from lactose intolerance. Sheep milk can also be a good alternative for such infants especially when complimented with fresh fruits and juices which can help fulfill the calcium requirements of an infant’s body.How to test for lactose intolerance in infants?Before we talk about temporary lactose intolerance in infants, let us examine more closely, what lactose intolerance is. Lactose intolerance refers to the inability to digest the sugar lactose. This is due to a deficiency of the lactase enzyme. Lactase is necessary to break down lactose so that it can be absorbed by the small intestine. When this does not occur, it results in lactose being poorly digested. Lactose intolerance in infants occurs under three conditions. Firstly, a baby can be born with an inability to digest lactose intolerance. This is a rare condition and is known as primary lactose intolerance. Temporary lactose intolerance in infants or secondary lactose intolerance occurs after an attack of gastroenteritis (or a stomach flu or a tummy upset). This condition as the name suggests is temporary. The third situation where this can develop it is acquired lactose intolerance. This rarely affects a child who is less than four years of age. Diagnosing lactose intolerance in infants is possible through various tests. One test for lactose intolerance in infants is the stool acidity test. Two others are the hydrogen breath test and the lactose intolerance test. Medical guidance is always recommended if you feel that your child may be suffering from this problem. Also see diet for lactose intoleranceHow to diagnose lactose intolerance in babies?If your baby is unable to digest the sugar in his milk, he is probably lactose intolerant. Lactose intolerance should not be mistaken for a milk allergy. If he were allergic to milk, he would have reacted to the protein in the milk. Lactose intolerance in babies is caused by a lactase deficiency. This intolerance could be primary or secondary. Diagnosing lactose intolerance in babies is quite simple and can be determined by the tests mentioned below. The different kinds of tests that one can use for diagnosing lactose intolerance in babies are the lactose intolerant test, hydrogen breath test, small bowel biopsy and a stool acidity test. In the first test, diagnosis is based on whether the blood sugar is raised or not, after consuming lactose rich drink. In the second, it is determined by the presence of hydrogen in the breath, due to the incomplete digestion of lactose. A small bowel biopsy is carried out only when the child is failing to pick up in health and reasons are unknown. The fourth test is based on the increased acidity in stools, due to incomplete lactose digestion. Treatment for lactose intolerance in babies is fairly easy and modifying their diet is the way to treat this condition.What are lactose intolerance symptoms in newborns?Lactose intolerance is a condition which occurs when there is difficultly in processing lactose in the body. Newborns could suffer with primary, secondary or genetic lactose intolerance. Symptoms of lactose intolerance in newborns are as given below. Most newborns who suffer from lactose intolerance will suffer from diarrhea, bloating or gas, or abdominal cramping. These signs of lactose intolerance in newborns usually occur about 30 minutes to two hours after drinking breast milk. Other lactose intolerance symptoms in newborns include plenty of burps following feeding. If you feel that your newborn is exhibiting the lactose intolerance symptoms mentioned above, do seek medical guidance. There are a few tests that can diagnose whether your newborn suffers from lactose intolerance or not.Your doctor may even suggest eliminating all sources of lactose from your baby’s diet till the symptoms subside. Proper treatment can be started once a diagnosis has been made. Treatment for lactose intolerance in newborns includes avoiding all dairy products and any products that contain lactose. Switching to a lactose free formula could help as well. If this does not help the condition, check with your doctor about giving your baby a soy formula. Medical guidance is recommended if you have a newborn with this problem.Does lactose intolerance cause constipation in toddlers?Lactose intolerance and constipation in toddlers is connected as can be seen from the reasons given below. If you have started including whole milk and not formula in your baby’s diet and your baby is suffering from constipation daily, then the culprit might be lactose intolerance. Lactose is a sugar found in milk or dairy or milk based products. Lactose intolerance is a condition that occurs when there is a deficiency of lactase in the body and therefore there is an inability to digest the sugar lactose. This could be a lifelong condition or also the result of some infection. Symptoms of lactose intolerance include gas and abdominal bloating, pain in the abdomen, nausea, and diarrhea. In some cases, lactose intolerance could induce constipation as well. In most cases however, lactose intolerance is known to cause diarrhea and not constipation. The symptoms given above occur within minutes to a few hours of ingesting milk or dairy products. Diagnosis of lactose intolerance is possible by conducting a few tests such as the lactose intolerance test, stool acidity test or a hydrogen breath test. If you suspect that your toddler is suffering from lactose intolerance, it is recommended that you seek medical attention immediately. Treatment can then be started accordingly.。
3种方法对儿童幽门螺杆菌感染检测的比较_何艳明
期 Ｈｐ感染主要是通过粪－口、口－口传播，随着儿童与外界接触 增多，感染 Ｈｐ的机会也增大。大便取材 方 便，无 创 伤，家 长 容 易 接 受 ，方 便 临 床 推 广 应 用 。
１．４ １３ Ｃ 尿素呼气试验 采 用 北 京 优 你 特 药 业 有 限 公 司 提 供 的诊断试剂盒。 ２ 结 果
６４例患儿大便 Ｈｐ抗原、血清 Ｈｐ抗体、１３ Ｃ 尿素呼气试验 的灵 敏 度 分 别 为 ９５．９％、９５．６％、９７．９％；特 异 性 分 别 为 ９３．３％、７７．８％、９３．８％；诊 断 符 合 率 分 别 为 ９５．３％、９０．６％、 ９６．９％，见表１。其中１３ Ｃ 尿 素 呼 气 试 验 灵 敏 度 、特 异 性 、诊 断 符合率最高，分 别 为 ９７．９％、９３．８％、９６．９％，其 次 为 大 便 Ｈｐ 抗原 检 测，其 灵 敏 度、特 异 性、诊 断 符 合 率 分 别 为９５．９％、 ９３．３％、９５．３％。血清 Ｈｐ 抗 体 检 测 的 灵 敏 度 尚 可 （９５．６％）， 但其特异性（７７．８％）及诊断符合率（９０．６％）较１３ Ｃ 尿素呼气试 验及大便 Ｈｐ抗原检测低。
ｆｅｃｔｉｏｎ ｉｎ ｃｈｉｌｄｒｅｎ． Ｋｅｙ ｗｏｒｄｓ：ｃｈｉｌｄｒｅｎ； Ｈｅｌｉｃｏｂａｃｔｅｒ ｐｙｌｏｒｉ； ｈｅｌｉｃｏｂａｃｔｅｒ ｉｎｆｅｃｔｉｏｎｓ／ｄｉａｇｎｏｓｉｓ； ｌａｂｏｒａｔｏｒｙ ｔｅｃｈｎｉｑｕｅｓ ａｎｄ ｐｒｏｃｅｄｕｒｅｓ
幽门螺杆菌（Ｈｐ）为 上 消 化 道 疾 病 的 主 要 致 病 菌，其 感 染 不但与胃炎、胃溃疡及 非 溃 疡 性 消 化 不 良 有 关，而 且 与 黏 膜 相 关性淋巴组织（ＭＡＬＴ）淋巴 瘤 和 胃 癌 也 有 重 要 关 系［１］，Ｈｐ 许 多 是 儿 童 期 感 染 获 得 ，若 未 及 时 发 现 并 进 行 相 应 的 治 疗 会 严 重 危害健康。因此，选择合适的诊断方法对儿 童 Ｈｐ感 染 早 期 诊 断尤为重要。本研究采用３种非侵入性 方 法：大 便 Ｈｐ抗 原 检 测、血清 Ｈｐ抗体检测 及１３ Ｃ 尿 素 呼 气 试 验 对 儿 童 Ｈｐ 感 染 检 测进行评估，旨在为儿童 Ｈｐ感染非侵入性诊 断 方 法 的 选 择 提 供 依 据 ，现 报 道 如 下 。 １ 资 料 与 方 法 １．１ 一般资料 选择组织病理学检查和快速尿素酶实验确 诊 为 Ｈｐ感染患儿６４例，其中男 ３９ 例，女 ２５ 例；年 龄 ３～１３ 岁。 分 别 采 集 大 便 及 血 液 ，分 离 血 清 。 １．２ 大 便 Ｈｐ 抗 原 检 测 用 免 疫 层 析 法 检 测 大 便 Ｈｐ 抗 原， 试 剂 盒 由 北 京 荣 志 海 达 生 物 科 技 有 限 公 司 提 供 ，所 有 操 作 按 照 说明书进行。 １．３ 血清 Ｈｐ抗体检 测 采 集 患 儿 空 腹 静 脉 血，用 免 疫 胶 体 法检测血清 Ｈｐ－ＩｇＧ 抗体，试剂盒 由 新 加 坡 ＭＰ 生 物 医 学 亚 太 私人有限公司提供。操作严格按试剂说明书进行。
甲烷和氢呼气使用手册
甲烷和氢呼气使用手册甲烷和氢呼气试验解决了很多其它试验难以检查的项目以及一些无法完成的检测盲区，譬如胰腺功能检查、小肠细菌过增长、肠道通过时间以及乳糖酶缺乏症，都是其它检查方法都不能完成的“盲区”。
呼气检测方法是一种无创、无痛、准确、环保、快捷技术，具有广泛的临床应用价值。
检测前需要做好准备工作。
∙禁食12小时∙头天晚餐不吃不易消化的食物。
∙晚饭后至测试前不喝含糖的饮料。
∙清晨清洁口腔。
∙不吸烟、不喝酒。
∙避免剧烈运动。
空腹基础值的解释：H2 <10ppm：正常H2 10-20ppm：禁食不充分或晚餐进食不宜消化食物。
H2 >20ppm：考虑小肠细菌过度生长该技术的应用范围涵盖40%-60%的胃肠疾病，消化科、儿科、体检中心、内分泌科、胃肠及肝胆外科等临床科室都可开展。
1填补国内外胰腺功能检查的盲区，诊断胰腺炎后的胰腺损伤程度可评价糖尿病的病因和预后。
2诊断和治疗不明原因的长期腹泻及腹胀、消化不良综合症、儿童和成人的乳糖酶缺乏症、小肠细菌过度生长。
3慢性便秘的病因测定肠道通过时间和回盲瓣功能障碍。
4诊断糖尿病患者自主神经节病变所致的胃肠动力异常。
5对慢性结肠炎合并碳水化合物吸收不良，确定其肠道感染状况及是否有吸收不良暨严重程度。
6评价亚健康状况常伴有小肠细菌过度生长最常用的几种氢呼气试验1、支链淀粉呼气试验(测定胰腺外分泌功能)用一定负荷量的支链淀粉作试验餐，可诊断胰腺损伤程度，这个试验填补目前国内外胰腺功能无法检测的盲区。
评估胰腺炎后胰腺功能损伤和糖尿病患者的病因和预后。
2、乳果糖呼气试验(用于小肠细菌过量增长、口盲通过时间、回盲瓣功能不良)适应症：慢性腹泻或慢性结肠炎功能性肠病，消化不良综合症、慢性肝病或肝硬化糖尿病患者的胃肠动力异常慢性便秘亚健康状态3、乳糖呼气试验(测定乳糖酶缺乏症、小肠细菌过增长、胃肠通过时间)适应症：乳糖酶缺乏症或不耐症各种功能性肠病慢性腹泻或慢性肠炎肠道预激综合症的诊断胃肠或肝胆外科手术后肠道功能恢复的评估。
儿童胃炎(英文)--重庆医大
Acute infection: Corrosive substances:
5
Acute gastritis
Manifestations
④ Manifestations
A sudden onset Typical manifestations: epigastric pain, nausea, vomiting, watery diarrhea Fever: caused by bacterial infection or its toxins Complications: dehydration, electrolyte disturbances, acid-base imbalance, UGI bleeding
19
Chronic gastritis
Diagnosis
Recurrent abdominal pain and/or dyspeptic symptom in children
Gastroendoscopic examination History: Inappropriate dietary habits, family history, medication taking, psychological stress
NGM
27
Hemorrhagic gastritis
NGM
Hemorrhagic gastritis with multiple intramural bleec Lymphoid Hyperplasia
NGM
Normally there is no organized lymphoid tissue in the stomach.
24
Chronic gastritis
乳糖酶缺乏与乳糖不耐受症状的临床特点分析
现代消化及介入诊疗2221年第26卷第2期Mob/n Dig/tion&Bd/vexUon222/Veh26,No.2-179-.论著.乳糖酶缺乏与乳糖不耐受症状的临床特点分析张宸山，郑中文2,布小玲2,许凌丽5,胡裕荣5,宁雨露2棊佩妍7赖卓成2沙卫红22【摘要】目的探讨乳糖酶缺乏及乳糖不耐受症状的临床特点。
方法回顾性分析了84例于广东省人民医院门诊就诊的以腹痛、腹泻、腹胀、肠鸣为主要症状的患者,并接受胃肠镜、腹部CT、抽血及氢呼气试验等检查评估,根据患者的主要诊断，氢呼气试验结果及乳糖不耐受症状进行分组，比较各组的临床指标，包括年龄、性别、体质量指数、血常规、过敏原检测、血清总蛋白及白蛋白、c-反应蛋白、血沉等指标及氢呼气试验结果。
结果功能性腹泻、肠易激综合征组相较于其他功能性胃肠病组、器质性疾病组，岀现乳糖不耐受症状的比例更高(P<105)o相比乳糖不耐受症状阴性组，乳糖不耐受症状阳性组患者的体质量指数、血清总蛋白及血清白蛋白水平降低，且差异均具有统计学意义(P<2.05)。
不同乳糖酶缺乏程度各组患者在合并器质性疾病、食物不耐受、乳糖不耐受症状上无明显差别(P>2.05),白细胞计数、血红蛋白、中性粒细胞计数、血清总蛋白、血清白蛋白、C-反应蛋白及血沉等指标比较差异也无统计学意义(P>2.05)。
结论进食乳制品后是否岀现症状与乳糖酶是否缺乏或缺乏程度之间缺乏一致性。
是否存在乳糖酶缺乏似乎对患者的营养情况并无明显影响，但岀现自我报告的乳糖不耐受症状的患者相比无症状者长期营养状况趋于下降。
【关键词】乳糖酶缺乏;乳糖不耐受;临床特点;氢呼气试验;营养中图分类号:R374.7文献标志码:A DOI：12.3969/j.i/u1072-2159.222(.22.205Preliminaro discussion foo the deereec of aduih lactase deficiency and its canicai signincanccZHANG Chen12,ZHENG Zhoog-wen22,BU Xiao-Un2,XU Ling-lt3,HU Yu-rong3,NIAG Yu-lu1,QI Pei-yan,LAA Zhuo-cheng', SHA Wei-Uong111.Thn Second Schoo)of COnicai Meeiciae,Sontaem Meicai U niversita,Guaagzhon,510515,Chiaa；2.af Gastmenterolof,, Guaagdong Provinciai People's hospitai(Guangdong Academa of Medea)Sciences),Guaagzhon,511080,China；3.General Prachco, DasPt Streei Commuuita HeaH Servica Cenas f Panya Distrid,Guaagzhon,511133,China；4.General Prachco,Guaagdong Interoationai Traven HeaU Care Centre,Guaagzhon,511035,China[Abstroct I Objective The aim of this study is to investigate the clinical characteUstics of objective lactase defi/enca and sudjective lactose intolerance symptoms.Methodt89ootyaUex-s w:ith a/dominal pain；diarrUea；a/dominal distension and borUoryymus as the main symptoms were included and evaluated by endoscone,a/dominal CT,bloop samp/ng and hyprogex breath test (HBT):The padexts were divi/ed into diWerext groops accorUing to the main diagnosis,HBT results and subjective lactose intolerance symptoms.The clinical indexes of each gronx were compared including age ,sex,boby mass index,bloop rootine ,detection of aderaen,serum total protein ,aldumin,Cgeaction protein ,erythrocyte sedimedtado/rate and the results of HBT.R su O c The WiciUexco of subjective lactose intolerance symptoms was higher in padexts with i/Ua/le bowel syp/rome and fu/c/oogl diarrUea compared to padexts w:ith other functional diseases vs oryanic diseases(P<2.05).Compared w:ith paUexts withoot subjective lactose intolerance symptoms,those w:ith symptoms showed Uwes level of BMI,serum total protein and serum aldumin,the diWerexces were statistically sig/ficant(P<2.05).There was no significant diWerexco on the coexistence of oryanic diseases,the i/cibe/ce of foob intolerance and subjective lactose intolerance,wh/e bloop cell coo/t,/e/Woohil coo/t,hemogUbin；serum total protein,serum albumin ,ESR and C RP among padexts w:ith diWerext deyrecs of iactaso deficie/ca(P> 2.05).Conclasion there is a lacO of co/siste/ca between subjective lactose intolerance symptoms and objective lactase deficiency.Objective lactase deficie/ca does not seem to have a sig/ficant edect on the n/triLo/gl status of padexts,but the long-term n/Witional status of patients with sudjective lactose作者单位：510515南方医科大学第二临床医学院；512080广东省人民医院(广东省医学科学院)消化内科;3511432广州市番禺区大石街社区卫生服务中心，全科医学;4510635广州国际旅游卫生保健中心，全科医学通信作者：沙卫红E-mad:wh-sha@#共同第一作者基金项目：广东省中医药局科研项目(26271209)-173-现代消化及介入诊疗262-年第26卷第2期M o P uu DiJutWp&Utemention262-,Veb26,No.2intolerance symptoms tends to be PeclineP compareP w:ith asymptomatic patients.【Key wordst Lactase peficienca；Lactose intolerance symptoms；C/nicai chamcte/shcs；Hypmgep breath tesh Nutrition乳糖酶缺乏在世界范围内普遍存在，其发生率随种族和地区而异,在我国的发病率约为75%~120%[1]o如肠道乳糖酶缺乏，导致乳糖在小肠内无法被完全分解吸收，进入结肠后易被细菌分解并产生氢气，呼出的氢气量可以通过氢呼气试验（hyPmgep breath test,HBT）检测，是诊断乳糖酶缺乏的金标准。
lactose_intolerance
drink will be acidic (< pH 6) in cases of intolerance. This indicates fermentation of undigested sugars by the colonic bacteria.6For absolute confirmation, a double-blind placebo-con-trolled food challenge should be done. This helps iden-tify individuals who may be convinced of intolerance despite normal lactase levels and no symptoms after ingestion of reasonable lactose intakes.2 Treatment and managementSymptoms are alleviated by complete elimination or reduced consumption of lactose-containing foods. Most lactose-intolerant adults can consume some lac-tose without major symptoms, thereby reducing the need for strict elimination of dairy products. Regular milk consumption in some lactose-intolerant individuals has been found to increase the threshold tolerance level at which diarrhoea occurs as a result of colonic adaptation. Tolerance also seems improved when lac-tose-foods are eaten as part of a meal.2,3,7,10,16Some health professionals consider soy-based infant formulas to be the milk substitute of choice in lactose-intolerant infants. There are also lactose-free cow’s milk-based formulas available.Better tolerated dairy products include more solid and semi-solid forms such as cheeses (which cause delayed and slower gastric emptying) and yoghurt or cultured dairy products. Yoghurt and fermented milk products improve lactose digestion and eliminate symptoms of lactose intolerance. Yoghurt with lactic-acid-producing bacteria (including Lactobacillus and Streptococcus spp.) has showed health benefits for lac-tose intolerance in some studies. These beneficial effects are due to microbial beta-galactosidases pre-sent in the fermented milk products, delayed gastro-intestinal transit, positive effects on intestinal functions and colonic microflora, reduced sensitivity to symp-toms and enhancement of gastrointestinal innate and adaptive immune responses. Fermentation of dairy products also breaks down much of the lactose into its monosaccharides. Frozen yoghurt is however not well accepted as freezing destroys the microbial enzyme.2,3,7,12,15-19Inconsistent results regarding the benefit of yoghurt may be due to differences in bacteria strains used, routes of administration, or investigational procedures; further robust studies will clarify these factors.19 Lactose-containing medication, vitamin supplements and certain sweeteners/ additives may pose a problem for severely intolerant individuals.20Commercial forms of the lactase enzyme exist in both liquid and tablet forms (Liquid Lactase, Lactaid) and var-ious milk products have been treated with lactase (Parmalat Zymil) to facilitate better digestion and a less restrictive diet. There appears to be no need for these preparations however when the dosage of milk is limit-ed to 1 cup.2,3,6,16,21Dairy products with added probiotics (Lactobacillus and Bifidobacterium spp.) may modulate gut microbial com-position, leading to improved gut health and lactose intolerance symptoms. However, more research is needed regarding the therapeutic application of probi-otics in this condition.3,12,22When dairy products (and therefore excellent sources of calcium (75% of dietary calcium consumed), phos-phorous, magnesium, vitamin A, riboflavin and protein) are eliminated, adequate nutrition must be provided in both growing children and adults to ensure appropriate bone growth, development and mineralisation, and to avoid rickets and osteoporosis.2,3,20,23,24Dietary management strategies to increase calcium consumption in lactose-intolerant groups should include:•Dairy foods consumed with meals•Yoghurt and other fermented dairy products •Calcium-fortified foods•Using digestive aids•Dairy foods daily in the diet to enhance colonic metabolism of lactose.Good non-dairy sources of calcium, phosphorous, mag-nesium and protein include soya milk, soya yoghurt, tofu, canned fish (including the bones), seeds and nuts, beans and other legumes, dark green leafy vegetables, oranges and some calcium-fortified breakfast cereals and fruit juices. Additional calcium supplementation is suggested to achieve the dietary reference intake for calcium (1 000-1 300 mg/day for adults). Individuals also need to obtain adequate vitamin D from moderate sunlight (approximately 30-60 minutes a day depending on age) and vitamin-D-enriched foods, e.g. mar-garine.2,3,5,6,10,20,23,24Public awareness and misunderstanding of lactose intolerance are at an all time high. Scientific findings indicate that the prevalence of actual intolerance is grossly overestimated and many people erroneously believe they have developed intolerance symptoms and eliminate dairy products unnecessarily from their diet.2A recent study suggests an increase in individually, self-described ‘lactose intolerance’ with subsequent restric-tion of dairy and calcium intake that is a cause of serious concern. These individuals demonstrated reduced peak bone mass, increased incidence of osteopenia and greater risk of osteoporosis and bone fractures. Food challenges may be helpful in these cases, as seen in a study where individuals with self-reported lactose intolerance did not differ in response to milk chocolate samples containing different amounts of lactose. In two other reports, a third and a half of the lactose-intolerant subjects in the respective studies experienced symptoms to both a lactose-containing and lactose-hydrolysed milk under double-blind condi-tions, further highlighting the influence of social and cultural beliefs and attitudes towards milk toler-ance.2,12,25,26,27,28Health professionals should alleviate patients’ fears about lactose intolerance, discuss the importance of calcium-rich foods, and recommend dietary strategies to improve lactose tolerance only when intolerance is clinically proven.2,12,25,26How much lactose can be tolerated? Lactose intolerance is dose related; however, the degree of lactose malabsorption differs greatly among individuals, and a positive diagnosis does not mean all lactose-containing foods need to be eliminated. Most lactose-intolerant adults can consume some lactose without major symptoms, but the literature expresses differing views on how much is needed to cause actu-al clinical symptoms.2,3,6Age and the size (weight) of the individual will affect the actual amount of lactose that can be tolerated before symptoms develop; e.g., a 6-year-old child of 12 kg is unlikely to tolerate the same amount of milk that can be safely consumed by a 60 kg adult with the same degree of intolerance severity.Symptoms of lactose intolerance seem rarely to cause distress until more than 4-12 g lactose (100-240 ml milk) is ingested. Ingestion of low levels of lactose (below 7 g) shows no difference in non-specific intoler-ance. A large psychological element was reported as no differences in symptoms were found between sub-jects who consumed 7 g of lactose and subjects who consumed no lactose. Consumption of quantities greater than 12 g (equivalent of 240 ml milk) usually leads to bloating, flatulence, abdominal cramps and diarrhoea. Another source suggests safe ingestion of 200-400 ml of milk daily. Adults with more moderate intolerance may be able to adapt, developing tolerance to more than 12 g lactose if amounts are increased gradually over 6-12 weeks.3,7,12,16Symptoms tend to occur after large quantities of lac-tose (>50 g) are taken in a single dose. Cheese without lactose (hard and semi-hard cheese) or low in lactose (soft cheese contains only 10% lactose) can usually be consumed. Yoghurt with approximately one-third less lactose than milk is often well tolerated as previously mentioned.4,11,29,30People with laboratory-confirmed low levels of lactase enzyme can safely consume 1 serving of milk (1 cup = 12 g lactose) with a meal or 2 servings of milk (2 cups) per day in divided doses with breakfast and dinner. Symptoms tend to occur as the lactose load is increased, with the majority of individuals having symp-toms when the equivalent of 1 litre of milk is ingested in a single dose. People who describe themselves as severely ‘lactose intolerant’ may mistakenly attribute a variety of abdominal symptoms to lactose intolerance. In the majority of patients a lactose intake limited to approximately 1 cup of milk (240 ml) leads to negligible symptoms, and use of lactose digestive aids are unnec-essary.2,21,31To further demonstrate whether a usual lactose intake (2 cups milk daily with meals) could be consumed by lactose maldigesters, a double-blind, randomised crossover study was conducted in two groups with confirmed positive hydrogen breath tests – those who believed they were symptomatic and those who believed lactose intake did not induce symptoms. Both groups reported only minimal symptoms after intake of regular or lactose-free milk, reaffirming that most self-described lactose-intolerant subjects can easily tolerate 2 cups of milk daily when consumed in divided doses with breakfast and dinner.2,32The high incidence figures for primary lactose maldigestion among groups grossly overestimate the number who will clinically react after drinking a glass of milk with a meal. Randomised, double-blind, controlled clinical trials have demonstrated that by using a few simple dietary strategies, those who maldigest lactose can easily tolerate a dairy-containing diet that meets calcium intake recommendations. Health professionals can help these patients and the general public under-stand how to improve calcium nutrition by overcoming the enormous barrier of lactose intolerance and in so doing reduce the incidence of calcium-related chronic diseases in high-risk populations.12,33Lactose intolerance may offer p rotection against large-bowel diseasesResearch has found a reduced incidence of ‘developed society’ large-bowel diseases such as diverticulitis, colo-rectal adenomas and carcinomas, ulcerative colitis and Crohn’s disease in African black people. This disparity exists despite an adopted urbanised lifestyle and changes in dietary patterns including decreased fibre intake (from 30-35 g to 12-14 g daily). It is hypothesised that the increased concentration of substrate available for fermentation in the colon due to carbohydrate mal-absorption in the group, compensates for the low dietary fibre intake. This would be protective of the large bowel, and helpful in the prevention of large-bowel disease in the African population.34 Controversial areasSymptoms of irritable bowel syndrome (IBS) resemble the non-specific reactions of lactose intolerance. Subjects with IBS tend to self-diagnose lactose intoler-ance and eliminate dairy without evidence that the foods are solely responsible for symptoms. Research suggests that a lactose-restricted diet should be reserved only for patients who demonstrate symptoms of diarrhoea, abdominal pain and flatulence during hydrogen breath testing, irrespective of what was pre-viously reported. Certain individuals may benefit occa-sionally from a reduced lactose load; however, this should not be general practice in IBS patients. These patients should be reassured that small amounts of lac-tose are unlikely to cause abdominal symptoms even in lactose-intolerant individuals with demonstrated symp-toms.16,35Infantile colic has been linked to lactose intolerance; however, research remains inconclusive. Although there is no consensus as yet about its aetiology, it is likely to be multifactoral. Two randomised controlled tri-als found no benefit from lactase treatment of breast milk or cow’s milk formula. One double-blind placebo-controlled study found a modest but variable benefit from pre-incubation of foods with lactase. As yet, low lactose or lactose-free formulas or pretreatment of feeds with lactase are not recommended as treatment for colic.4Inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) are commonly treated by exclusion of dairy products; however, most affected people are able to consume a glass of milk daily without discomfort. The prevalence of lactose intolerance tends to be greater in Crohn’s patients with small-bowel involve-ment than those with colon involvement or ulcerative colitis. In the latter colonic conditions, lactose malab-sorption is as a result of ethnic risk, based on genetic factors. Bacterial overgrowth and/or small-bowel transit time may also be responsible for lactose malabsorption in Crohn’s disease.36Despite these findings, dairy avoidance in these patients is extensive and can be attributed to patient misconceptions, as well as poor medical advice and minimal nutritional consultation. It is suggested that all IBD patients receive hydrogen breath tests to ensure better nutritional management, and avoid unnecessary dairy elimination and prescription of commercial lactase preparations.36Conflicting evidence exists regarding links between lac-tose intolerance and an increased risk of cataract for-mation, development of diabetes and ovarian cancer.12 TO SUMMARISE IN PRACTICEEach lactose-intolerant person, with the help of a qual-ified dietitian, should determine his or her own thresh-old and adjust the amount of lactose that can be consumed comfortably at any one time. Strategies to help with the inclusion of milk and other dairy products in the diet without experiencing symptoms include:2,6•Low amount of lactose consumed.The larger the amount consumed, the greater the risk of symp-toms. Most lactose-intolerant individuals can safely tolerate 1 cup of milk (12 g lactose), especially if taken with a meal or other foods, or 2 cups milk per day in divided doses at breakfast and dinner. •Consumption of a meal or solid food.Consuming lactose with a meal or solid food may improve toler-ance as it slows gastric emptying and delivery of lac-tose to the colon, allowing more opportunity for any available endogenous lactase to digest the lactose.•Correct types of dairy food.Certain dairy foods are better tolerated than others; e.g. full cream milk is better than lower fat milk. Chocolate milk may also be better tolerated than unflavoured milk, but the mechanisms by which cocoa reduces intolerance are unknown.Other dairy products with lower lactose content than milk may be better tolerated, e.g. cheeses (Cheddar, Swiss, Parmesan, cottage cheese) and ice cream.Harder cheeses tend to have even less lactose, as the lactose-containing whey is removed from the curd during the cheese-making process. Lactose totally disappears in mature ripened cheeses.Fermented/cultured dairy products with beta galac-tosidase are better digested. Yoghurt, sour milk, and amasi are among these. Yoghurt should contain live, active cultures as pasteurisation reduces the benefi-cial effects of the bacterial cultures on lactose diges-tion.•Lactose-reduced or lactose-free dairy foods or lac-tose digestive aids.For the rare cases in which a patient is unable to tolerate even small amounts of lactose, or when large amounts of lactose-containing foods are eaten, commercially available lactose-reduced milk and other dairy products are available.A lactase preparation (liquid) can also be added athome to regular milk and left overnight. An oral enzyme replacement tablet, that can withstand the stomach’s acidity, can be taken at the beginning of a meal. These products are expensive and are unnec-essary if the equivalent of 1 cup milk/ day can be tol-erated.•Gradual increase of intake of dairy foods.Tolerance to lactose can be improved by gradually increasing intake of lactose-containing foods. Lactose tolerance threshold can also be determined in this way.E limination of lactose from the diet may actuallyworsen lactose intolerance in people with primary lactase deficiency.REFERENCES1.Bahna SL. Cow’s milk allergy versus cow’s milk intolerance. AnnAllergy Asthma Immunol.2002; 89(Suppl 1): 56-60.2.McBean LD, Miller GD. Allaying fears and fallacies about lactoseintolerance. J Am Diet Assoc1998; 98(6): 671-676.3.Mahan LK, E scott-Stump S. Krause’s Food, Nutrition and DietTherapy. 10th ed. Philadelphia: WB Saunders, 2000: Chapter 31: 679-681.4.Metcalfe D, Sampson H, Ronald A. Food Allergy: Adverse Reactionsto Foods and Food Additives.Oxford: Blackwell, 2003: 212-214, 484-4855.Rusynyk RA. Lactose intolerance. J Am Osteopath Assoc 2001; 101(Suppl 1): 10S-12.6.Joneja JV. Dealing with Food Allergies.Bull Publishing, 2003:Chapter 8: 136-149.7.Marteau P. In: Emerton V, ed. Food Allergy and Intolerance. CurrentIssues and Conc erns.Surrey: Leatherhead International, 2002: Chapter 10: 102-113.8.Sibley E. Genetic variation & lactose intolerance: detection meth-ods and clinical implications. Am J Pharmacogenomics2004; 4(4): 239-245.9.Swallow DM. Genetics of lactase persistence and lactose intoler-ance. Annu Rev Genet 2003; 37: 197-219.10.Inman-Felton AE. Overview of lactose maldigestion (lactose non-persistence). J Am Diet Assoc 1999; 99(4): 481-489.11.Swagerty DL, Walling AD, Klein ctose intolerance. Am FamPhysician2002; 65(9): 1845-1850.12.Vesa TH, Marteau P, Korpela ctose intolerance. J Am Coll Nutr2000; 19(suppl 2): 165S-175S.13.Zhong Y, Priebe MG, Vonk RJ.The role of colonic microbiota in lac-tose intolerance. Dig Dis Sci2004; 49(1): 78-83.14.Romagnuolo J, Schiller P, Bailey RJ, et ing breath tests wise-ly in gastroenterology practice: an evidence-based review of indi-cations and pitfalls in interpretation. Am J Gastroenterol2002; 97(5): 113-126.15.De Vriese M, Stegelmann A, Richter B, et al.Probiotics – compen-sation for lactase insufficiency. Am J Clin Nutr2001; 73(Suppl 2): 421S-429S.16.Beyer PL. Gastrointestinal disorders: roles of nutrition and thedietetics practitioner. J Am Diet Assoc1998; 98(3): 272-277.17.Solomons NW. Fermentation, fermented foods and lactose intoler-ance. Eur J Clin Nutr2002; 56(Suppl 4): S50-55.18.Stanton C, Gardiner G, Meehan H, et al.Market potential for probi-otics. Am J Clin Nutr. 2001; 73(Suppl 2): 476S-483S19.Adolfsson O, Megdani SN, Russell RM.Yoghurt and gut function.Am J Clin Nutr 2004; 80(2): 245-256.20.Wright T. Food Allergies. Enjoying Life with a Severe Food Allergy.London: Class publishing, 2001: 76-81.21.Suarez FL, Savaiano DA, Levitt MD.Review article: the treatment oflactose intolerance. Aliment Pharmacol Ther1995; 9(6): 589-597.22.Monalto M, Arancio F, Izzi D, et al.Probiotics: history, definition,requirements and possible therapeutic applications. Ann Ital Med Int 2002; 17 (3): 157-165.23.Prentice A. Diet, nutrition and the prevention of osteoporosis.Public Health Nutr2004; 7(1A): 227-243.24.Jackson KA, Savaiano DA. Lactose maldigestion, calcium intakeand osteoporosis in African-, Asian-, and Hispanic-Americans. J Am Coll Nutr2001; 20(Suppl 2): 198S-207S.25.Savaiano D. Lactose intolerance: a self-fulfilling prophecy leading toosteoporosis? Nutr Rev2003; 61(pt1): 221-223.26.Jarvinen RM, Loukaskorpi M, Uusitupa MI.Tolerance of sympto-matic lactose malabsorbers to lactose in milk chocolate. Eur J Clin Nutr2003; 57(5): 701-705.27.Johnson AO, Semenya JG, Buchowski MS, et al.Correlation of lac-tose maldigestion, lactose intolerance and milk intolerance. Am J Clin Nutr1993; 57: 399-401.28.Vesa TH, Korpela RA, Sahi T.Tolerance of small amounts of lactosein lactose maldigestors. Am J Clin Nutr1996; 64: 197-201.29.De Vrese M, Sieber R, Stransky ctose in human nutrition.Schweiz Med Wochenschr 1998; 128(38): 1393-400.30.Sieber R, Stransky M, de Vriese ctose intolerance and con-sumption of milk and milk products. Z Ernahrungswiss1997; 36(4): 375-393.31.Suarez FL, Savaiano DA, Levitt MD.A comparison of symptomsafter consumption of milk or lactose-hydrolyzed milk by people with self-reported severe lactose intolerance. N Engl J Med1995;333: 1-4.32.Suarez FL, Savaiano DA, Arbisi P, Levitt MD.Tolerance to the dailyingestion of 2 cups of milk by individuals claiming lactose intoler-ance. Am J Clin Nutr1997; 65: 1502-1506.33.Jarvis JK, Miller GD. Overcoming the barrier of lactose intoleranceto reduce health disparities. J Natl Med Assoc2002; 94(2): 55-56.34.Segal I. Physiological small bowel malabsorption of carbohydratesprotects against large bowel disease in Africans. J Gastroenterol Hepatol2002; 17(3): 249-252.35.Vernia P, Marinaro V, Argani F, et al.Self-reported milk tolerance inirritable bowel syndrome: what should we believe? Clin Nutr2004;23: 996-1000.36.Mishkin S. Dairy sensitivity, lactose malabsorption and eliminationdiets in inflammatory bowel disease. Am J Clin Nutr1997; 65: 564-567.。
圣乔治评分
SGRQ圣乔治呼吸问卷圣•乔治医院呼吸问题调查问卷(SGRQ)这份问卷是用来帮助我们更进一步了解你的呼吸问题是如何正在困扰你的，以及它是如何影响你的生活的。
我们通过它发现疾病在哪一方面对你的影响最大,但这不是医生或护士所认为的那些问题。
请仔细阅读下列指导性语句，若有不明白之处请提问。
不要花费太长的时间来决定你的答案。
在完成余下的问卷前，请选择一个能体现你目前健康状况的描述并在小框中打“√”：很好¨(1) 好¨(2) 一般¨(3) 不好¨(4) 很差¨(5)第一部分关于在过去3个月内有关你的呼吸困难问题，每个问题只选择一个答案。
一周中的绝大部分时间一周中有几天一个月中的几天仅在有肺部感染时没有1. 在过去4周内，咳嗽：¨(4) ¨(3) ¨(2) ¨(1) ¨(0)2. 在过去4周内，我咳过痰：¨¨¨¨¨3. 在过去4周内，我出现呼吸急促：¨¨¨¨¨4. 在过去4周内，我出现喘息发作：¨¨¨¨¨5. 在过去4周内，你有过几次严重的或极不舒服的呼吸困难发作？超过3次¨(4) 3次发作¨(3) 2 次发作¨(2) 1次发作¨(1) 没有发作¨(0)6. 最严重的一次呼吸困难发作持续多长时间（若没有严重发作则跳过此题直接回答第7题）？一周或更长时间¨(3) 3天或更长时间¨(2) 1至2天¨(1) 不超过1天¨(0)7. 在过去4周内，平均每周有几天是正常的（几乎没有呼吸困难）？请选择一个答案. 没有一天正常¨(4) 1到2天正常¨(3) 3 至4天正常¨(2) 几乎每一天都是正常的¨(1) 每一天都正常¨(0)8. 如果你有喘息，是否在清晨醒来时加重？如果你没有喘息，直接回答文卷的第二部分. 否¨(0) 是¨(1)第二部分一．你将如何描述你目前的呼吸困难？请选择一个合适的框并打“√”：呼吸困难使我受到最严重的困扰¨(3) 呼吸困难使我受到相当多的困扰¨(2) 呼吸困难使我受到一些困扰¨(1) 呼吸困难没有使我受到困扰¨(0)如果你曾经有过工作，请从中选择一项：我的呼吸问题使我完全终止工作¨(2) 我的呼吸问题影响我的工作或使我变换工作¨(1) 我的呼吸问题不影响我的工作¨(0)二．下面问题是关于这些天来下列哪些活动经常让你觉得喘不过气来。
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11Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 2Division of Clinical Pharmacology and Toxicology, Dana-Dwek Children's Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and 4Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND:
Lactose malabsorption affects 70% of the world population. The hydrogen breath test (HBT) is used clinically to test for this condition. The aim of our study was to describe the relationship between symptoms experienced before and during the HBT and test results.
METHODS:
We included children who underwent the HBT in the pediatric gastroenterology unit at Dana-Dwek Children's Hospital during a 6-month period. Previous symptoms and those experienced before and after the HBT were assessed using a questionnaire and a
validated pain scale.
RESULTS:
Ninety-five children were included in the study, and 66.3% had a positive HBT. Diarrhea and flatulence during the test were significantly more frequent in the group with a positive HBT compared to those with a negative test (31.7% vs. 9.4%, P = 0.016 and 69.8% vs.
40.6%, P = 0.006, respectively). The frequency of abdominal pain and bloating was
similar.
CONCLUSIONS:
Diarrhea and flatulence during the HBT are the most specific symptoms of lactose
intolerance. Abdominal pain should not be automatically attributed to lactose intolerance even in the presence of lactose malabsorption. Coupling the HBT with a real-time
questionnaire facilitates interpretation of results and subsequent recommendations.。