清肺通络合剂对气阴两虚兼痰热型社区获得性肺炎患者肠道菌群多样性的影响  

Effect of Qingfei Tongluo mixture on intestinal flora diversity in patients with community-acquired pneumonia of Qi-yin deficiency and phlegm-heat type

作　　者：翁卫东[1] 饶先林[1] 陆峰彬 金燕[1] 柴可群[1] WENG Wei-dong;RAO Xian-lin;LU Feng-bin;JIN Yan;CHAI Ke-qun(Department of Infection,Zhejiang Provincial Tongde Hospital,Hangzhou 310012,China)

机构地区：[1]浙江省立同德医院感染科,杭州310012

出　　处：《浙江中西医结合杂志》2023年第2期117-122,共6页Zhejiang Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的 探讨中药清肺通络合剂(QFTLM)对气阴两虚兼痰热型社区获得性肺炎(CAP)患者肠道菌群多样性的影响。方法 采用前瞻性临床对照研究方法,根据患者采用的治疗方法不同,将23例气阴两虚兼痰热型CAP患者分为两组:予抗菌药物治疗组10例,予抗菌药物联合QFTLM治疗组13例。收集治疗前后患者粪便样本46份,利用PacBio测序平台进行16S rRNA测序,分析两组患者治疗前后样本中肠道菌群的组成、多样性和显著性差异物种。结果 (1)两组治疗前后肠道菌群的组成:在门水平为厚壁菌门、变形杆菌门、拟杆菌门、疣微菌门和放线菌门;在纲水平为梭菌纲、革兰阴性菌纲、芽孢杆菌纲、丹毒丝菌纲、拟杆菌纲、γ-变形杆菌纲、疣微菌纲和放线菌纲;在目水平为拟杆菌目、梭菌目、单胞菌目、肠杆菌目、乳杆菌目、丹毒丝菌目和颤螺菌目;在科水平为拟杆菌科、乳球菌科、肠杆菌科、韦荣球菌科、艾克曼菌科、毛螺菌科、喜热菌科、链球菌科、丹毒丝菌科和肠球菌科;在属水平为拟杆菌属、粪杆菌属、埃希氏菌属、罕见小球菌属、巨单胞菌属、艾克曼菌属、梭菌属、链球菌属和肠球菌属。(2)两组治疗前后梭菌纲的相对丰度抗菌药物组治疗前后为(0.48±0.24)比(0.17±0.14)(P<0.01);抗菌药物联合QFTLM组治疗前后为(0.42±0.20)比(0.17±0.15)(P<0.05)。(3)两组治疗后α多样性较治疗前显著减少:抗菌药物组治疗前后Ace指数为(96.40±9.56)比(63.33±7.56)(P<0.05),PD_whole_tree指数为(6.43±0.56)比(4.63±0.55)(P<0.05);抗菌药物联合QFTLM组治疗前后Shannon指数为(3.82±0.27)比(2.79±0.40)(P<0.05)。两组治疗前后β多样性差异不显著,主坐标分析显示第一主成分贡献率为30.74%。(4)两组显著性差异物种分析结果显示:抗菌药物组治疗前为厚壁菌门、梭菌纲、梭菌目和瘤胃球菌属,治疗后为链球菌科、链球菌属和唾液链球菌种;抗菌Objective To assess the effects of Qingfei Tongluo mixture(QFTLM) on intestinal flora diversity in patients with community-acquired pneumonia(CAP) of Qi-yin deficiency and phlegm-heat type.Methods A total of 23 such patients were enrolled in this study and randomly divided into control and treatment groups.The control patients(n=10) were treated with antibiotics alone,whereas treatment group of patients(n=13)received antibiotics plus QFTLM.Thereafter,46 fecal samples were collected and analyzed for composition,microbial diversity,and different species before and after treatment in both groups of patients using the 16S r RNA sequencing on PacBio platform.Results Both groups of patients before and after treatment showed the composition of microflora as Firmicutes,Proteobacteia,Bacteroidetes,Verrucomicrobia,and Actinobacteria at phylum level before and after treatment in both groups;Clostridia,Negativicutes,Bacilli,Erysipelotrichale,Gammaproteobacteria,Verrucomicrobiae,and Actinobacteria at class level;Bacteroidales,Clostridiales,Selenomonadales,Enterobacterales,Lactobacillales,Erysipelotrichaceae,and Oscillospirales at the order level;Bacteroidaceae,Ruminococcaceae,Enterobacteriaceae,Veillonellaceae,Akkermansiaceae,Lachnospiraceae,Caloramatoraceae,Streptococcaceae,Erysipelotrichaceae,and Enterococcaceae at family level;Bacteroides,Faecalibacterium,Escherichia,Megamonas,Subdoligranulum,Akkermansia,Clostridium,Streptococcus,and Enterococcus at genus level.The relative abundance of clostridia was statistically significant in two groups before and after treatment,i.e.,0.48 ±0.24 vs.0.17 ±0.14(P <0.01)in control group and0.42±0.20 vs.0.17±0.15(P<0.05)in treatment group of patients.Furthermore,the treatment significantly reduced theα diversity in both groups of patients,i.e.,96.40±9.56 vs.63.33±7.56(P<0.05)of the Ace index and 6.43±0.56 vs.4.63±0.55(P<0.05)of PD_whole_tree index in control group and 3.88±0.27 vs.2.79±0.40(P<0.05)of the Shannon index in treatment group.However,there was no significant differenc

关 键 词：清肺通络合剂 社区获得性肺炎 抗菌药物 肠道菌群 16S rRNA测序 

分 类 号：R259[医药卫生—中西医结合]