糖尿病微血管并发症患者肠道菌群的特征分析  

Characteristics analysis of gut microbiota in diabetic microvascular complications patients

作　　者：高珊 刘晓燕[2] 张爱敏 何建秋[2] 高宇[2] Gao Shan;Liu Xiaoyan;Zhang Aimin;He Jianqiu;Gao Yu(Graduate School of Chengde Medical College,Chengde 067000,China;Department of Endocrinology,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院研究生院,承德067000 [2]承德医学院附属医院内分泌科,承德067000

出　　处：《中华糖尿病杂志》2022年第2期166-172,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：河北省政府资助专科带头人培养项目(2018361008)。

摘　　要：目的探讨糖尿病微血管并发症(DMC)患者的肠道菌群特征。方法选取2019年9月至2020年11月于承德医学院附属医院内分泌科住院治疗的2型糖尿病(T2DM)患者。收集患者年龄、性别、吸烟史、收缩压、舒张压、体重指数(BMI)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰转移酶(GGT)、肌酐(CRE)、胰岛素的使用情况等指标,以及拟杆菌属、普雷沃菌属、双歧杆菌属等肠道菌群含量。依据是否合并微血管并发症将患者分为糖尿病微血管并发症(DMC)组和单纯糖尿病(DM)组。采用t检验、Mann-Whitney U检验或χ^(2)检验对两组间各指标及肠道菌群含量进行比较。采用Spearman相关分析法分析肠道菌群与各指标的相关性。采用多因素logistic回归分析法分析DMC患病的危险因素。结果共纳入患者79例。其中,DMC组47例,DM组32例。与DM组相比,DMC组的拟杆菌属含量增加,普雷沃菌属、双歧杆菌属含量下降,差异均有统计学意义(P<0.05)。多因素logistic回归分析模型结果显示,随着拟杆菌属含量的增加,DMC患病率增加(OR=1.053,95%CI 1.016~1.091,P=0.005),在校正年龄、性别、吸烟史、收缩压、舒张压、BMI、HbA1c、血脂、肝酶、CRE、胰岛素的使用情况等混杂因素后,拟杆菌属仍为DMC的危险因素(OR=1.085,95%CI 1.023~1.151,P=0.007);随着普雷沃菌属含量的增加,DMC患病率下降(OR=0.843,95%CI 0.737~0.965,P=0.013),在校正以上混杂因素后,普雷沃菌属仍为DMC的保护因素(OR=0.822,95%CI 0.681~0.993,P=0.042)。结论DMC患者肠道中存在菌群紊乱,随着拟杆菌属和普雷沃菌属含量的增加,DMC患病率分别出现增加和下降的不同结果,拟杆菌属为DMC的危险因素,普雷沃菌属为DMC的保护因素。Objective To explore the characteristics of gut microbiota in patients with diabetic microvascular complications(DMC).Methods From September 2019 to November 2020,patients with type 2 diabetes mellitus(T2DM)who were hospitalized in Department of Endocrinology,Affiliated Hospital of Chengde Medical College were enrolled.Age,gender,smoking history,systolic blood pressure,diastolic blood pressure,body mass index(BMI),glycated hemoglobin A1c(HbA1c),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),glutamic pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),γ-glutamyltransferase(GGT),creatinine(CRE),use of insulin,and gut microbiota contents such as Bacteroides,Prevosiella and Bifidobacterium were collected.According to whether there were microvascular complications,patients were divided into diabetic microvascular complications(DMC)group and diabetes mellitus(DM)group.The t-test,Mann-Whitney U test,orχ^(2)-test were used for comparison of each index and gut microbiota content between the two groups.Spearman correlation was used to analyze the correlation between gut microbiota and each index.Multivariate logistic regression analysis was used to analyze the risk factors for DMC disease.Results A total of 79 patients were enrolled.Of these,47 were in the DMC group and 32 in the DM group.Compared with the DM group,the content of Bacteroides significantly increased in the DMC group,the contents of Prevotella and Bifidobacterium significantly decreased in the DMC group(P<0.05).Multivariate logistic regression analysis showed that the incidence of DMC increased with the increase of Bacteroides(OR=1.053,95%CI 1.016—1.091,P=0.005).After adjusting for age,sex,history of smoking,systolic pressure,diastolic pressure,BMI,HbA1c,blood lipids,liver enzyme,CRE,and use of insulin confounding factors,Bacteroides was a risk factor for DMC(OR=1.085,95%CI 1.023—1.151,P=0.007).The incidence of DMC decreased with the increase of Prevobella(OR=0

关 键 词：糖尿病 2型 肠道菌群 糖尿病微血管并发症 拟杆菌属 普雷沃菌属 

分 类 号：R587.2[医药卫生—内分泌]