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肝硬化营养不良患者肠道菌群的组成特征分析

毕炯炯 马英杰

引用本文:
Citation:

肝硬化营养不良患者肠道菌群的组成特征分析

DOI: 10.12449/JCH240115
基金项目: 

河南省医学科技攻关计划-省部共建项目 (2018010044)

伦理学声明:本研究方案于2021年9月4日经由郑州人民医院伦理委员会审批,批号为2021001016。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:毕炯炯负责课题设计,收集整理数据,撰写论文;马英杰负责拟定写作思路,指导论文撰写和修改。
详细信息
    通信作者:

    马英杰, mayingjie19@sina.com (ORCID: 0000-0002-6692-5992)

Characteristics of the composition of intestinal flora in cirrhotic patients with malnutrition

Research funding: 

Henan Medical Science and Technology Research Plan-Provincial Co-construction Project (2018010044)

More Information
  • 摘要:   目的  研究肝硬化营养不良患者肠道菌群的组成特征和血清内毒素水平,旨在为提高肝硬化患者的营养状况提供新的诊疗思路。  方法  收集2021年3月—2022年11月在郑州人民医院消化内科住院的58例肝硬化患者作为试验组(LC组),根据皇家自由医院营养优先排序工具分为低营养不良风险组(LC-A组,n=28)和中/高营养不良风险组(LC-B组,n=30),并选择同期25例健康体检者作为对照组(HC组)。采集所有受试对象的外周血和粪便样本,用鲎试剂凝胶法检测外周血内毒素浓度,并用高通量测序技术及生物信息学分析肠道菌群间的特征。正态分布的计量资料两组间比较采用成组t检验,多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验。相关性分析采用Spearman检验。  结果  三组ALT(H=7.054)、GGT(H=9.644)、Alb(F=32.768)、TBil(H=20.980)及血清内毒素水平(F=108.672)差异均有统计学意义(P值均<0.05)。三组间Chao1指数比较差异有统计学意义(F=5.110,P=0.008),HC组与LC-B组Chao1指数比较差异有统计学意义(P<0.05)。与HC组比较,LC-A组、LC-B组的Chao1指数和Shannon指数均下降,HC组与LC-B组Chao1指数比较差异有统计学意义(P<0.05)。在门水平上,各组主要由拟杆菌门(Bacteroidota)、厚壁菌门(Firmicutes)、变形菌门(Proteobacteria)和放线菌门(Actinobacteriota)组成,并占总体门类的95%以上,HC组与LC-B组厚壁门相对丰度差异有统计学意义(P<0.05)。血清内毒素与瘤胃菌科呈显著负相关(r=-0.420,P=0.007)。螺旋体与TBil呈显著正相关(r=0.419,P=0.007),与Alb呈显著负相关(r=-0.492,P=0.001)。  结论  肝硬化营养不良患者中存在独特的肠道菌群改变,并且差异菌群与内毒素血症存在相关性,改善肝硬化肠道微生态可能有助于改善营养状况。

     

  • 图  1  肠道菌群主要属(前20位)相对丰度百分比

    Figure  1.  Relative abundance percentage of major genera (top 20) of intestinal flora

    图  2  肠道菌群属水平物种相对丰度比较

    Figure  2.  Comparison of relative abundance of species at genus level of gut microbiota

    图  3  肠道差异菌群与临床指标的关系

    Figure  3.  Relationship between gut differential flora and clinical indicators

    表  1  各组基本资料

    Table  1.   Basic information of each group

    项目 HC组(n=25) LC-A组(n=28) LC-B组(n=30) 统计值 P
    年龄(岁) 54.68±8.56 57.19±11.21 59.10±9.67 F=2.004 0.139
    男性[例(%)] 12(48.00) 19(67.86) 20(66.67) χ 2=3.384 0.184
    ALT(U/L) 20.00(17.70~26.62) 29.00(29.34~74.45)1) 26.00(24.66~103.34)1) H=7.054 0.029
    AST(U/L) 35.00(29.14~39.98) 35.00(35.04~69.38) 46.00(40.55~112.74) H=2.929 0.231
    GGT(U/L) 26.00(22.42~50.30) 61.00(41.29~139.71)1) 49.00(67.09~134.06)1) H=9.644 0.008
    Alb(g/L) 41.80±4.54 37.54±6.021) 31.23±6.461)2) F=32.768 <0.001
    TBil(μmol/L) 20.20(19.33~29.32) 20.20(17.56~33.34) 41.30(38.35~61.79)1)2) H=20.98 <0.001
    内毒素(EU/mL) 0.04±0.02 0.19±0.071) 0.32±0.111)2) F=108.672 <0.001
    注:与HC组比较,1)P<0.05;与LC-A组比较,2)P<0.05。
    下载: 导出CSV

    表  2  各组肠道菌群丰度和多样性比较

    Table  2.   Comparison of the abundance and diversity of intestinal flora in each group

    项目 HC组(n=25) LC-A组(n=28) LC-B组(n=30) F P
    Chao1指数 215.75±74.18 191.76±70.41 159.25±53.311) 5.110 0.008
    Shannon指数 5.15±0.89 5.02±0.86 4.59±1.23 2.271 0.110
    注:与HC组比较,1)P<0.05。
    下载: 导出CSV

    表  3  各组肠道菌群门水平相对丰度组成比较

    Table  3.   Composition comparison of relative abundance of intestinal flora at phylum level in each group

    项目 HC组(n=25) LC-A组(n=28) LC-B组(n=30) H P
    拟杆菌门 65.24(34.99~73.87) 47.89(36.85~58.42) 60.30(44.50~65.76) 1.357 0.507
    厚壁菌门 9.94(7.04~44.30) 12.19(11.13~32.08) 4.02(3.85~14.93)1) 6.217 0.045
    变形菌门 15.85(9.91~26.62) 26.30(20.19~35.21) 26.10(22.25~37.01) 4.230 0.121
    放线菌门 0.58(0.23~1.67) 0.73(0.66~3.24) 0.55(0.41~5.53) 1.739 0.419
    注:与LC-A组比较,1)P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2023-04-10
  • 录用日期:  2023-05-03
  • 出版日期:  2024-01-23
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