慢性胰腺炎患者肠道微生态的变化及其与胰腺内外分泌功能不全的关系  

Alteration of the gut microbiota in patients with chronic pancreatitis and its relationship with exocrine or endocrine dysfunction

作　　者：孟雨亭 徐佳佳 周春华[1] 赵九龙[1] 周玮[1] 蒋琪 张尧 邹多武[1,2] MENG Yuting;XU Jiajia;ZHOU Chunhua;ZHAO Jiulong;ZHOU Wei;JIANG Qi;ZHANG Yao;ZOU Duowu(Department of Gastroenterology,Shanghai Changhai Hospital,Shanghai 200433,China;不详)

机构地区：[1]上海长海医院消化内科,上海200433 [2]上海交通大学附属瑞金医院消化内科

出　　处：《上海医学》2019年第10期583-589,共7页Shanghai Medical Journal

摘　　要：目的研究慢性胰腺炎(CP)患者肠道微生态的变化情况及其与胰腺内外分泌功能不全的关系。方法选择2017年8月—2018年9月于上海长海医院消化内科住院治疗的CP患者行横断面研究。通过住院病历系统收集30例不伴糖尿病的CP患者(不伴糖尿病组)和31例伴糖尿病的CP患者(伴糖尿病组)的临床资料。将60例入组患者的健康家属作为对照组。使用无菌容器收集受试者粪便,检测粪弹力蛋白酶1(FE1)水平并进行16S rRNA测序。通过京都基因和基因组全书(KEGG)行同源性分析,预测代谢通路。分析物种丰度、KEGG通路与BMI、空腹血糖(FGB)、血红蛋白(Hb)、FE1间的关系。结果伴糖尿病组患者病程显著长于不伴糖尿病组患者,FGB水平、胰腺萎缩率均显著高于不伴糖尿病组患者,而FE1、Hb水平均显著低于不伴糖尿病组患者(P值均<0.01)。与对照组比较,CP患者肠道微生态紊乱明显,其中伴糖尿病组患者菌群紊乱更为严重,表现为厚壁菌门相对丰度显著降低,变形菌门、小杆菌属和普氏菌7属相对丰度显著升高。伴糖尿病组脂多糖合成通路和脂多糖合成蛋白通路显著富集。普氏菌7属相对丰度与脂多糖合成、脂多糖生物合成蛋白通路均呈显著正相关(r=0.295,P=0.001;r=0.262,P=0.004),与FE1水平呈显著负相关(r=-0.425,P=0.001)。结论变形菌门、小杆菌属和普氏菌7属相对丰度显著升高可作为辅助诊断CP并发糖尿病的依据,普氏菌7属丰度亦可辅助判断CP患者胰腺外分泌功能状况。Objective To explore the changes of intestinal microecology of chronic pancreatitis(CP) patients and the correlation between exocrine or endocrine dysfunction with such changes. Methods CP patients hospitalized in the department of gastroenterology of Changhai Hospital from August 2017 to September 2018(30 without diabetes mellitus, 31 with diabetes mellitus) were enrolled in this study. Their healthy family members were included as healthy controls(n=60). Fecal samples were collected for 16 S rRNA sequencing and fecal elastase 1(FE1) detection. Homology analysis was performed with Kyoto encyclopedia of genes and genomes(KEGG). Metabolic pathway was predicted. The correlation between species abundance, KEGG and these parameters(body mass index [BMI], fasting blood-glucose [FBG], hemoglobin [Hb], FE1) were analyzed. Results CP patients with diabetes mellitus had significantly longer disease duration, higher pancreatic atrophy rate and FBG level than CP patients without diabetes mellitus, while the levels of FE1 and HB were significantly lower than those without diabetes mellitus(P<0.01). CP patients showed significant intestinal microecological disorder, among which the flora disorder was more serious in patients with diabetes mellitus. In the patients with diabetes mellitus, the relative abundance of Phylum Firmicutes was significantly decreased, Proteobacteria, Dialister and Prevotella7 were significantly increased, and the lipopolysaccharide(LPS) synthesis pathway and LPS synthesis protein pathway were significantly enriched. Meanwhile, the abundance of Prevotella7 was positively correlated with LPS synthesis pathway(r=0.295, P=0.001) and LPS biosynthesis pathway(r=0.262, P=0.004), while it was negatively correlated with FE1 level(r=-0.425, P=0.001). Conclusion The notablely increased Proteobacteria, Dialister and Prevotella7 can be taken as auxiliary diagnostic evidence of CP combined with diabetes mellitus. The abundance of Prevotella7 can help to judge the pancreatic exocrine function of CP patients.

关 键 词：慢性胰腺炎 肠道微生态 3C型糖尿病 胰腺外分泌功能不全 

分 类 号：R576[医药卫生—消化系统]