微生态制剂干预对社区糖尿病肾病患者肠道菌群的影响研究  

Influence of Microbiota-modulating Agents on Gut Flora in Community Patients with Diabetic Nephropathy

作　　者：沈菲[1] 蒋伟萍[1] 梅小斌 韩一平 赵家义 樊剑 顾娟[1] 沈雁红 徐红梅 张丹 门英[1] 丁海光[1] 陈彩萍 韩君华 SHEN Fei;JIANG Weiping;MEI Xiaobin;HAN Yiping;ZHAO Jiayi;FAN Jian;GU Juan;SHEN Yanhong;XU Hongmei;ZHANG Dan;MEN Ying;DING Haiguang;CHEN Caiping;HAN Junhua(Department of General Practice,Yinhang Community Health Center,Shanghai 200438,China;Department of Nephrology,Changhai Hospital,Naval Military Medical University,Shanghai 200433,China;Department of General Practice,Changhai Hospital,Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]上海市杨浦区殷行社区卫生服务中心全科,200438 [2]海军军医大学附属长海医院肾内科,上海市200433 [3]海军军医大学附属长海医院全科医学科,上海市200433

出　　处：《中国全科医学》2023年第9期1112-1117,共6页Chinese General Practice

基　　金：上海市杨浦区科委课题(YP18M12);上海市“医苑新星”青年医学人才培养资助计划[沪卫计人事(2019)72号]。

摘　　要：背景肠道微生态结构和多样性变化导致的菌群失调在糖尿病和慢性肾脏病中发挥着与疾病互相影响的作用。合理应用益生菌、益生元等微生态制剂有利于帮助糖尿病肾病患者调节肠道菌群,对糖尿病肾病的慢性炎症具有积极治疗作用,并对延缓肾功能进一步恶化具有一定的作用。目的根据糖尿病肾病患者肠道菌群变化选择微生态制剂进行干预并了解其疗效。方法采用分层随机抽样的方式选取2019年在上海市杨浦区殷行社区卫生服务中心就诊的115例糖尿病肾病患者,采用简单随机抽样法将患者分为对照组57例(行常规治疗)和治疗组58例(行微生态制剂干预),对比两组患者治疗8周后各实验室检查指标以及肠道细菌培养结果。结果115例糖尿病肾病患者中男28例、女87例,平均年龄为(62.9±10.0)岁,糖尿病肾病病程为(14.3±7.1)年。对照组和治疗组患者男性比例、年龄、体质指数、早期糖尿病肾病比例、糖尿病肾病病程比较,差异均无统计学意义(P>0.05)。与对照组相比,干预后治疗组患者空腹血糖、三酰甘油、血尿素氮、血肌酐、尿微量白蛋白与尿肌酐比值、胱抑素C、C反应蛋白、白介素1β、肿瘤坏死因子α均降低,高密度脂蛋白、估算的肾小球滤过率均升高(P<0.05)。干预后,治疗组患者肠球菌(Z=16.482,P<0.001)、肠杆菌(Z=5.138,P<0.001)菌落数低于对照组,双歧杆菌(Z=2.470,P=0.014)、乳酸杆菌(Z=8.384,P<0.001)菌落数高于对照组。结论微生态制剂对于糖尿病肾病患者的肠道菌群具有调节作用,干预后治疗组患者肠道肠球菌、肠杆菌菌落数较对照组低,双歧杆菌、乳酸杆菌菌落数较对照组高。Background Imbalanced gut flora caused by changes in gut microecological structure and diversity plays an important role in the interaction between diabetes and chronic kidney disease.Rational application of probiotics,prebiotics and other microbiota-modulating agents is contributive to the improvement of gut microbial flora environment and chronic inflammation,as well as the delay of deterioration of renal function in patients with diabetic nephropathy(DN).Objective To understand the effect of probiotics,a microbiota-modulating agent,administered based on gut flora status in patients with DN.Methods Participants were selected from Shanghai Yinhang Community Health Center by use of stratified random sampling in 2019,including 115 patients with DN were randomly divided into control group(57 with usual treatment)and treatment group(58 with treatment with microbiota-modulating agents).Laboratory test indices and intestinal bacterial culture results were compared between the two groups after eight weeks of treatment to assess the effect of microbiota-modulating agents on improving gut flora in DN.Results Among 115 patients with DN,there were 28 males and 87 females,the mean age was(62.9±10.0)years,and the duration of diabetic nephropathy was(14.3±7.1)years.There were no significant differences in the proportion of males,mean age,body mass index,proportion of early DN,and duration of DN between DN patients with usual treatment and those with microbiota-modulating agents treatment(P>0.05).Compared with DN patients with usual treatment,DN patients with microbiota-modulating agents treatment had decreased levels of glucose,triglyceride,blood urea nitrogen,serum creatinine,albumin to creatinine ratio,Cystatin C,C-reactive protein,interleukin-1β,and tumor necrosis factor-α,and increased levels of high-density lipoprotein and estimated glomerular filtration rate after treatment(P<0.05).Moreover,DN patients with microbiota-modulating agents treatment showed lower numbers of Enterococcus(Z=16.482,P<0.001)and Enterobacter(

关 键 词：糖尿病肾病 肠道菌群 益生菌 干预研究 菌群失调 慢性炎症 肠道黏膜屏障 社区卫生中心 

分 类 号：R587.24[医药卫生—内分泌]