肥胖2型糖尿病患者代谢性手术治疗后肠道菌群的变化  

Changes in intestinal flora in obese patients with type 2 diabetes after metabolic surgery

作　　者：张翠兰 李杨[2] 苏佩琼 黎宝仁 蓝燕 ZHANG Cui-lan;LI Yang;SU Pei-qiong;LI Bao-ren;LAN Yan(Department of Endocrinology,Hainan Western Central Hospital,Hainan 571700,China;Department of General Surgery,Zhuozhou Hospital)

机构地区：[1]海南西部中心医院内分泌科,海南儋州571700 [2]河北省涿州市医院普外科

出　　处：《中国病原生物学杂志》2021年第3期348-351,358,共5页Journal of Pathogen Biology

摘　　要：目的观察肥胖2型糖尿病(T2DM)患者代谢性手术治疗后肠道菌群变化并分析其意义。方法选择2018年1月-2020年12月在本院接受Roux-en-Y胃旁路(RYGB)术的肥胖T2DM患者125例,16S rRNA序列检测法检查肠道菌群分布并进行比较分析;采用ELISA法检测血清总胆汁酸(TBA)、短链脂肪酸(SCFAs)、氨基酸、脂多糖(LPS)、氧化三甲胺(TMAO),分析肠道菌群变化与机体代谢的相关性。结果患者术后拟杆菌门、双歧杆菌、大肠埃希菌集落数分别为(8.44±1.40)Log_(10)、(5.42±0.93)Log_(10)、(4.01±0.63)Log_(10),与术前(7.73±1.22)Log_(10)、(5.16±0.87)Log_(10)、(4.23±0.59)Log_(10)比较差异均有统计学意义(均P<0.05)。术后TBA、乙酸盐、丙酸盐、LPS、TMAO分别为(3.88±0.96)μmol/L、(2.78±1.18)mmol/L、(3.88±1.17)mmol/L、(3.46±0.80)、(5.64±1.96),与术前(4.25±1.08)μmol/L、(3.22±1.27)mmol/L、(3.45±1.08)mmol/L、(3.71±0.87)、(6.33±2.03)比较差异均有统计学意义(均P<0.05)。拟杆菌门、双歧杆菌集落数与TBA、TMAO、LPS、乙酸盐水平呈负相关,与丙酸盐水平呈正相关(均P<0.05);大肠埃希菌与TBA、TMAO、LPS、乙酸盐水平呈正相关,与丙酸盐水平呈负相关(均P<0.05)。结论RYGB术治疗可改善肥胖T2DM患者肠道菌群紊乱和代谢水平,其治疗作用可能与代谢术通过改善肠道菌群而调节代谢水平有关。Objective To observe the changes in intestinal flora in obese patients with type 2 diabetes(T2 DM)after metabolic surgery and to analyze their significance.Methods Subjects were 125 obese patients with T2 DM who underwent Roux-en-Y gastric bypass(RYGB)surgery at this Hospital from January 2018 to December 2020.16 S rRNA sequencing was used to examine the distribution of intestinal flora,and a comparative analysis was performed.Serum total bile acids(TBA),short-chain fatty acids(SCFAs),amino acids,lipopolysaccharides(LPS),and trimethylamine oxide(TMAO)were measured using ELISA,and the correlation between changes in intestinal flora and body metabolism was analyzed.Results After surgery,there were 8.44±1.40 Log_(10) Bacteroides colonies,5.42±0.93 Log_(10) Bifidobacterium colonies,and 4.01±0.63 Log_(10) Escherichia coli colonies.The number of colonies differed significantly compared to preoperative results(7.73±1.22 Log_(10),5.16±0.87 Log_(10),and 4.23±0.59 Log_(10))(P<0.05).The level of postoperative TBA was 3.88±0.96μmol/L,that of acetate was 2.78±1.18 mmol/L,that of propionate was 3.88±1.17 mmol/L,that of LPS was 3.46±0.80,and that of TMAO was 5.64±1.96.Differences between those levels and preoperative levels(4.25±1.08μmol/L for TBA,3.22±1.27 mmol/L for acetate,3.45±1.08 mmol/L for propionate,3.71±0.87 mmol/L for LPS,and 6.33±2.03 mmol/L for TMAO)were significant(P<0.05).The number of Bacteroides and Bifidobacterium colonies was inversely correlated with levels of TBA,TMAO,LPS,and acetate and correlated with the level of propionate(P<0.05).The number of Escherichia coli colonies was correlated with levels of TBA,TMAO,LPS,and acetate and inversely correlated with the level of propionate(P<0.05).Conclusion A RYGB can alleviate disruption of intestinal flora and improve the level of metabolism in obese patients with T2 DM,and its effectiveness may be related to regulation of the level of metabolism by improving the intestinal flora via metabolic surgery.

关 键 词：Roux-en-Y胃旁路手术 2型糖尿病 肠道菌群 代谢指标 16S rRNA序列检测法 

分 类 号：R378[医药卫生—病原生物学]