肝硬化患者中医证型演变过程中肠道菌群结构变化及其临床意义  

Changes in the structure of intestinal flora and its clinical significance during the evolution of traditional Chinese medicine syndromes of liver cirrhosis

作　　者：郭晓霞[1] 叶永安 李小科 郭琲婷 吕蕾[1] 秦雪梅[3] GUO Xiao-xia;YE Yong-an;LI Xiao-ke(Shanxi provincial institute of traditional Chinese medicine,Taiyuan Shanxi,030012 China;不详)

机构地区：[1]山西省中医药研究院,山西太原030012 [2]北京中医药大学东直门医院 [3]山西大学中医药现代研究中心

出　　处：《中西医结合肝病杂志》2022年第12期1066-1072,共7页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

基　　金：山西省重点研发计划项目(No.201603D321042);北京中医药大学东直门医院中医内科学教育部重点实验室开放基金项目(No.2016-ZDSYSKFJJ-08)。

摘　　要：目的:探讨肝硬化患者中医证型演变过程中肠道菌群的分布特征,评价其与肝硬化严重程度的相关性。方法:收集10例健康志愿者与44例肝硬化患者的血液和粪便标本进行检验。16S rDNA高通量测序获得肝硬化不同中医证型患者间肠道菌群的差异菌属,使用Spearman相关性分析相关菌群属与临床指标的相关性,采用RDA分析驱动群落变异的主要影响因子。结果:随着肝郁脾虚证向湿热内蕴证的转化,患者病情加重,肠道屏障功能损伤严重,嗜黏蛋白阿克曼菌、青春双岐杆菌、狄氏副拟杆菌、普拉梭菌丰度下降,殊异韦荣球菌丰度上升。殊异韦荣球菌与ALT、AST、TBil、PT及肝硬化预后指标MELD、CTP呈显著正相关(P<0.001),普拉梭菌与ETX呈负相关(P<0.001),嗜黏蛋白阿克曼菌与肝硬化预后指标LSM、MELD呈负相关(P<0.001)。TBil、PT是驱动不同中医证型患者间肠道菌群群落变异的主要因子。其中TBil对菌群群落变异的影响差异有统计学意义(P=0.014)。结论:殊异韦荣球菌可能在肝硬化患者中医证型演变及病情发展中发挥重要作用,而调节青春双歧杆菌的含量可有效控制疾病进展。狄氏副拟杆菌协助普拉梭菌对于抑制肠道菌群移位具有重要调节作用。TBil是肝硬化两种中医证型间肠道群落变异的主要驱动因子。Objective:To investigate the distribution characteristics of intestinal flora in the evolution of TCM syndromes in patients with liver cirrhosis,and to evaluate its correlation with the severity of liver cirrhosis.Methods:Blood and stool samples were collected from 10 healthy volunteers and 44 patients with liver cirrhosis for examination.According to bacterial 16S rDNA high-throughput sequencing,differential bacteria in intestinal flora between different TCM syndromes in patients with liver cirrhosis was obtained.Spearman correlation was used to analyze the correlation between related flora and clinical indicators,and RDA was used to analyze the main influencing factors driving community variation.Results:With the transformation of the syndrome of liver depression and spleen deficiency into the syndrome of damp-heat,the condition of the patient was aggravated,the intestinal barrier function was seriously damaged,the abundance of Akermannia mucinophilus,Bifidobacterium adolescentis,Parabacteroides dielii,and Faecalibacterium prausnitzii decreased,while the abundance of Veillonella dispar increased.There was a significant positive correlation between the abundance of Veillonella dispar and ALT,AST,TBil,PT,MELD and CTP(P<0.001),while Praxellosis was negatively correlated with ETX(P<0.001).At the same time,the negative correlation between Akkerman mucophilus and LSM as well as MELD was just obvious(P<0.001).TBil and PT were the main factors driving the variation of intestinal community among different TCM syndrome types.TBil had the most significant impact on community variation(P=0.014).Conclusion:Isovirioncoccus may play an important role in the evolution of TCM syndromes and disease development of liver cirrhosis.The content of Bifidobacterium adolescentis can effectively control the progression of the disease.Faecalibacterium prausnitzii assisted by Parabacteroides distasonis have an important regulatory role in inhibiting the translocation of intestinal flora.TBil is the main driving factor of the intestinal co

关 键 词：肝硬化 中医证型 菌群失调 

分 类 号：R575.2[医药卫生—消化系统]