胆道菌群多样性与胆总管结石相关性的初步探讨  

Preliminary study on the correlation between diversity of biliary flora and recurrence of common bile duct stones

作　　者：查秀芳 徐顺福[2] 朱宏 陈晓星[2] 程文芳[2] 肖斌 陈国胜 倪金良[2] Zha Xiufang;Xu Shunfu;Zhu Hong;Chen Xiaoxing;Cheng Wenfang;Xiao Bin;Chen Guosheng;Ni Jinliang(Department of Gastroenterology,Jiangsu Provincial Geriatric Hospital,Nanjing 210024,China;Department of Gastroenterology,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Endoscopy Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Pancreatic Biliary Center,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]江苏省老年病医院消化内科,南京210024 [2]南京医科大学第一附属医院消化内科,210029 [3]南京医科大学第一附属医院内镜中心,210029 [4]南京医科大学第一附属医院胰胆中心,210029

出　　处：《中华消化杂志》2019年第12期850-854,共5页Chinese Journal of Digestion

摘　　要：目的初步探讨胆道菌群多样性与胆总管结石复发的相关性。方法选择2018年9月至2019年3月在南京医科大学第一附属医院行内镜逆行胰胆管造影术(ERCP)的48例患者,包括胆总管结石初发(初发组)患者38例和胆总管结石复发(复发组)患者10例。收集两组患者胆汁进行16S rRNA高通量测序分析。Chao1指数反映胆道菌群丰度,Shannon指数和Simpson指数反映胆道菌群多样性,并从门、纲、目、科、属、种的不同层面进行探究。采用卡方检验和t检验进行统计学分析。结果初发组Chao1指数高于复发组(419.413±118.704比396.000±70.483),差异有统计学意义(t=3.130,P=0.003)。在门水平上,初发组患者胆道内丰度最高为厚壁菌门(56.48%),复发组丰度最高为变形菌门(57.79%),复发组的优势菌群为变形杆菌,初发组的优势菌群为厚壁菌门,两组厚壁菌门和变形菌门分布差异均有统计学意义(χ^2=0.962、-2.619,P均<0.05)。在属水平上,复发组芽孢杆菌属与乳球菌属丰度均低于初发组(分别为9.75%比20.77%,10.86%比22.01%),差异均有统计学意义(χ^2=0.354、0.503,P均<0.05);复发组摩根氏菌属水平高于初发组(9.00%比0.44%),差异有统计学意义(χ^2=-2.025,P=0.049)。在种水平上,初发组芽孢杆菌属未分类、卡诺细菌、环状芽孢杆菌丰度高于复发组(分别为17.78%比8.84%,2.39%比1.11%,2.59%比0.74%),差异均有统计学意义(χ^2=2.540、2.643、2.515,P均<0.05),复发组气单胞菌丰度高于初发组(2.04%比0.01%),差异有统计学意义(χ^2=-2.397,P=0.021)。对初发组有显著差异性影响的细菌包括乳球菌属(P=0.012)、乳酸杆菌属(P=0.033)和芽孢杆菌属(P=0.021)等。对复发组有显著差异性影响的细菌包括肠杆菌属(P=0.007)、假单胞菌科(P=0.001)、放线菌纲(P=0.009)和产气单胞菌(P=0.001)等。结论复发组与初发组患者胆道菌群丰度和构成存在差异,复发组患者中某些菌群变化是否与胆总管结石�Objective To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones.Methods From September 2018 to March 2019,48 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis(primary group,38 patients)and recurrent choledocholithiasis group(recurrent group,10 patients).The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA.The Chao1 estimator indicated the richness of the biliary bacterial flora,and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora.The bacterial flora distribution was explored from different levels of phylum,class,order,family,genus and species.Chi-square test and t test were performed for statistical analysis.Results The Chao1 estimator of the primary group was higher than that of the recurrent group(419.413±118.704 vs.396.000±70.483),and the difference was statistically significant(t=3.130,P=0.003).At the level of the phylum,the highest abundance of bacteria in the primary group was Firmicute(56.48%),the highest abundance of bacteria in the recurrent group was Proteobacteria(57.79%).The dominant bacteria of the recurrent group was Proteobacteria,which was inconsistent with that of the primary group,and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups(χ^2=0.962 and-2.619,both P<0.05).At the genus level,the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group(9.75%vs.20.77%,10.86%vs.22.01%,respectively),and the differences were statistically significant(χ^2=0.354 and 0.503,both P<0.05).The abundance of Morganella of the recurrent group was higher than that of the primary group(9.00%vs.0.44%),and the difference was statistically significant(χ^2=-2.025,P=0.049).At the species level,the abundanc

关 键 词：胆总管结石 胆总管结石复发 胆道菌群 16S rRNA 

分 类 号：R657[医药卫生—外科学]