尿毒症患者肠道菌群变化的研究  

Evaluation of intestinal microflora in uremic patients

作　　者：王尊松[1] 崔美玉[1] 唐利军[1] 李文斌[1] 魏勇[1] 贾晓妍[1] 孔祥雷[1] 许冬梅[1] 

机构地区：[1]山东省千佛山医院肾内科,济南250014

出　　处：《中华肾脏病杂志》2014年第3期172-176,共5页Chinese Journal of Nephrology

基　　金：山东省自然科学基金（ZR2010HL012）

摘　　要：目的研究尿毒症患者肠道菌群变化的特点及其与炎性状态的关系。方法选择尿毒症非透析患者和透析患者各60例分为非透析组和透析组，另选择30例健康查体志愿者作为对照组，用实时荧光定量PCR（real—timePCR）检测粪便长双歧杆菌、嗜酸乳杆菌、粪肠球菌、大肠杆菌的表达，细菌浓度以每克粪便中该菌种基因拷贝数的对数表示，免疫散射比浊法测量患者超敏c反应蛋白（hs．CRP）。结果与对照组相比，尿毒症透析组和非透析组粪便长双歧杆菌（8．16±0．56和8．25±0．51比8．94±0．52，均P〈0．01）和嗜酸乳杆菌（7．22±0．62和7．42±0．59比8．11±O．61，均P〈0．01）浓度均明显降低。透析组略低于非透析组，但差异无统计学意义。与对照组相比，尿毒症透析组和非透析组粪便大肠杆菌（9．40±0．57和9．47±0．50比9．11±0．54，均P〈0．05）和粪肠球菌（8．07±0．57和8．06±0．55比7．75±0．55，均P〈0．05）浓度均明显升高。透析组与非透析组差异无统计学意义。以患者hs．CRP为因变量Y，4种肠道菌群浓度为自变量x，做逐步回归分析，选入方程的有嗜酸乳杆菌和粪肠球菌，回归方程为：Yhs-CRP=57．97—9．91X嗜酸乳杆菌＋2．26X粪肠球菌。结论尿毒症透析组和非透析组粪便长双歧杆菌和嗜酸乳杆菌浓度均明显降低，粪便大肠杆菌和粪肠球菌浓度均明显升高；嗜酸乳杆菌浓度降低及粪肠球菌浓度增加均可能加重尿毒症患者微炎性反应。Objective To evaluate the changes of intestinal microfiora in uremic patients and the relationship with inflammation. Methods Sixty uremic patients without hemodialysis, sixty uremic patients undergoing hemodialysis, and thirty healthy people as control were recruited in this study. Intestinal flora including Bifidobacterium longum, Lactobacillus acidophilus, Escherichia coli and Enterococcus faeealis were examed by Real-time PCR. The concentration of each bacterium was indicated by lg（eopy/gram feces）. Serum hypersensitive C- reactive protein （hs- CRP） were detected by immune nephelometry. Results The concentration of Bifidohacterium longum and Lactobaeillus acidophilus was significantly lower in hemodialysis group （8.16 ±0.56 and 7.22 ± 0.62） and non- hemodialysis group （8.25±0.51 and 7.42±0.59） than in control group （8.94±0.52 and 8.11±0.61, all P 〈 0.01）. The concentration of Enterococcus faecalis and Escherichia coli were significantly higher in hemodialysis group （8.07±0.57 and 9.40±0.57） and non-hemodialysis group （8.06±0.55 and 9.47±0.50） than those of control group （7.75±0.55 and 9.11 ±0.54, all P〈0.01）. There were no significant difference in the levels of these bacteria between non- hemodialysis and dialysis group. Stepwise regression analysis indicated that Lactobacillus acidophilus and Enterocoecus faecalis were intimately correlated with hs-CRP （P 〈 0.05）. The equation was： Yhs-CRp=57.97--9.91X＋2.26X . Conclusions The concentration of Bifidobacterium longum and Lactobacillus acidophilus decrease and Escherichia eoli and Enterocoecus faecalis increase in uremic patients. The decrease of Lactobacillus acidophilus and increase of Enterococcus faeealis may aggravate the microinflammation in uremic patients.

关 键 词：尿毒症 肠杆菌科 聚合酶链反应 

分 类 号：R692.5[医药卫生—泌尿科学]