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乙型肝炎肝硬化积证与臌胀肝肾阴虚证肠道菌群特征比较分析
Features of intestinal microbiota in hepatitis B cirrhosis patients with amassment or tympanites type of liver-kidney Yin deficiency syndrome: A comparative analysis
文章发布日期:2019年04月04日  来源:  作者:蔡文君,栾雨婷,刘成海,等  点击次数:326次  下载次数:96次

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【摘要】:目的比较分析乙型肝炎肝硬化积证与臌胀肝肾阴虚证患者肠道菌群的分布差异。方法选取2016年10月-12月上海中医药大学附属曙光医院肝硬化科病房住院的乙型肝炎肝硬化积证(无腹水)肝肾阴虚证患者21例和臌胀(伴有腹水)肝肾阴虚证患者15例,收集患者粪便样本,提取DNA,采用16S rRNA测序技术测序,比较两者肠道菌群的分布差异。计数资料2组间比较采用Wilcoxon秩和检验;计量资料2组间比较采用Mann-Whitney U检验。主成分分析采用R软件包(v.2.15.3)的ADE 4软件包,根据每个样本中的操作分类单元丰度,确定是否可以区分积证肝肾阴虚证和臌胀肝肾阴虚证。组间各物种相对丰度差异的比较采用多重假设检验,采用Benjamini和Hochberg错误发现率(FDR)进行调整,Pfdr<0.05为差异有统计学意义。结果在门的水平上,与积证肝肾阴虚证组比较,臌胀肝肾阴虚证组的变形菌门的丰度显著增加(Pfdr=0.009);拟杆菌门细菌的丰度显著减少(Pfdr=0048),放线菌门和硬壁菌门的丰度均有所减少,但2组间差异无统计学意义(Pfdr值均>0.05)。在属的水平上,与积证肝肾阴虚证组比较,臌胀肝肾阴虚证组变形菌门的肠杆菌属(Pfdr=0.035)和大肠杆菌-志贺菌属(Pfdr=0.007)丰度均显著增加;放线菌门的双歧杆菌属(Pfdr=0.009)和放线菌属(Pfdr=0.04),硬壁菌门的毛螺菌属(Pfdr=0.003)、丁酸弧菌属(Pfdr=0.009)、假丁酸弧菌属(Pfdr=0.041)、罗氏菌属(Pfdr=0.049)、柔嫩梭菌属(Pfdr=0.021)的丰度均显著减少。结论与积证肝肾阴虚证比较,臌胀肝肾阴虚证肠道菌群的特征为有益菌显著减少,条件致病菌显著增加。提示对臌胀肝肾阴虚证,在滋养肝肾的同时,也要重视涤荡胃肠,调节肠道菌群的失衡状态。
【Abstract】:ObjectiveTo investigate the distribution of intestinal microbiota in hepatitis B cirrhosis patients with amassment or tympanites type of liver-kidney Yin deficiency syndrome through a comparative analysis. MethodsA total of 21 hepatitis B cirrhosis patients with amassment type of liver-kidney Yin deficiency syndrome (without ascites) and 15 hepatitis B cirrhosis patients with tympanites type of liver-kidney Yin deficiency syndrome (with ascites) who were treated in Department of Liver Cirrhosis, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, from October to December, 2016 were enrolled as amassment group and tympanites group, respectively. Stool samples were collected, and DNA was extracted and sequenced by 16S rRNA sequencing technology. The Wilcoxon rank-sum test was used for comparison of categorical data;The Mann-Whitney U test was used for comparison of continuous data between groups. The ADE 4 software package of R package (v.2.15.3) was used for principal component analysis, and the abundance of operational taxonomic units (OTUs) in each sample was used to determine whether the amassment and tympanites types of liver-kidney Yin deficiency syndrome could be distinguished. Multiple hypothesis tests were used for comparison of relative abundance of each species between groups and were adjusted by Benjamini and Hochberg false discovery rate (FDR), and Pfdr<0.05 was considered statistically significant. ResultsCompared with the amassment group at the phylum level, the tympanites group had a significant increase in the abundance of Proteobacteria (Pfdr=0.009) and a significant reduction in the abundance of Bacteroidetes (Pfdr=0.048), as well as slight reductions in the abundance of Actinobacteria (Pfdr>0.05) and Firmicutes (Pfdr>0.05). Compared with the amassment group at the genus level, the tympanites group had significant increases in the abundance of Enterobacter (Pfdr=0.035) and Escherichia-Shigella (Pfdr=0007) of the Proteobacteria phylum, as well as significant reductions in the abundance of Bifidobacterium (Pfdr=0.009) and Actinomyces (Pfdr=0.04) of the Acfinobacteria phylum and the abundance of Lachnospira (Pfdr=0.003), Butyrivibrio (Pfdr=0.009), Pseudobutyrivibrio (Pfdr=0041), Roseburia (Pfdr=0.049), and Faecalibacterium (Pfdr=0.021) of the Firmicutes phylum. ConclusionCompared with the hepatitis B cirrhosis patients with amassment type of liver-kidney Yin deficiency syndrome, the patients with tympanites type have significant reductions in probiotic bacteria and significant increases in conditioned pathogens in intestinal microbiota, suggesting that in hepatitis B cirrhosis patients with tympanites type of liver-kidney Yin deficiency syndrome, besides liver-kidney nourishing therapy, stomach/intestine-cleansing therapy should also be adopted to regulate the imbalance of intestinal microbiota.
【关键字】:肝炎, 乙型; 肝硬化; 肝肾阴虚; 肠杆菌科
【Key words】:hepatitis B; liver cirrhosis; LIVER-KIDNEY YIN DEFICIENCY; enterobacteriaceae
【引证本文】:CAI WJ, LUAN YT, LIU CH, et al. Features of intestinal microbiota in hepatitis B cirrhosis patients with amassment or tympanites type of liver-kidney Yin deficiency syndrome: A comparative analysis[J]. J Clin Hepatol, 2019, 35(4): 785-789. (in Chinese)
蔡文君, 栾雨婷, 刘成海, 等. 乙型肝炎肝硬化积证与臌胀肝肾阴虚证肠道菌群特征比较分析[J]. 临床肝胆病杂志, 2019, 35(4): 785-789.

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