妊娠期糖尿病孕妇肠道菌群的组成变化及临床意义  

Composition changes and clinical significance of intestinal flora in pregnant women with gestational diabetes mellitus

作　　者：李华 曾智华[1] 陈秋玲[1] 彭冬梅[1] 邓燕霞 LI Hua;ZENG Zhihua;CHEN Qiuling;PENG Dongmei;DENG Yanxia(Department of Obstetrics,Changsha Hospital for Maternal&Child Health Care,Hunan Changsha 410000,China)

机构地区：[1]长沙市妇幼保健院产科,湖南长沙410000

出　　处：《中国妇幼健康研究》2023年第3期41-47,共7页Chinese Journal of Woman and Child Health Research

基　　金：湖南省卫生健康委科研课题(202205023515)。

摘　　要：目的 评估妊娠期糖尿病(GDM)女性怀孕期间微生物群的动态变化。方法 于2021年6月至12月从长沙市妇幼保健院连续招募31名GDM患者作为研究对象。在入组时(孕24~28周)和研究结束时(孕38周)对孕妇粪便微生物群(通过基于16S扩增子的测序)进行评估。结果 与孕妇入组时相比,研究结束时孕妇粪便微生物群α多样性值存在显著差异,表现在物种丰富度、菌种数量和香农指数显著升高(t值分别为6.752、7.623、6.539,P<0.05)。在属水平的箱线图显示,研究结束时Bacteroides、Collinsella和Rikenellaceae的丰度显著降低,而Blautia、Butyricicoccus、Clostridium、Coprococcus、Dorea、Faecalibacterium、L-Ruminococcus和Lachnospiraceae显著增加。Spearman相关性和多元回归分析结果显示,Faecalibacterium与蛋白质摄入呈正相关(ρ=0.34,P<0.05),而与空腹血糖变化呈负相关(ρ=-0.56,P<0.05)。Rikenecellaceae与收缩压呈负相关(ρ=-0.53,P<0.05)。Blautia与糖化血红蛋白(HbA1c)变化、空腹胰岛素变化和HOMA-IR变化呈负相关(ρ值分别为-0.53、-0.37、-0.37,P<0.05)。Butyricimonas、Collinsella与空腹胰岛素变化(ρ值分别为0.43、0.47,P<0.05)和HOMA-IR变化(ρ值分别为0.50、0.46,P<0.05)呈正相关。结论 GDM患者在妊娠期间检测到具有更高α多样性的微生物群组成的变化,以及代谢/炎症模式与特定细菌丰度之间的关联。Objective To assess the dynamic changes of microbiota during pregnancy in women with gestational diabetes mellitus(GDM).Methods A total of 31 GDM patients were consecutively recruited from the Changsha Hospital for Maternal&Child Health Care from June to December 2021.Fecal microbiota(by 16S amplicon-based sequencing) were assessed at enrollment(with the gestational age of 24-28 weeks) and at the end of the study(with the gestational age of 38 weeks).Results The microbiota α-diversity values were significantly different between subjects at enrolment when compared to subjects at the end of the study, and the species richness, number of different species and the Shannon index were significantly higher at the end of the study(t=6.752,7.623 and 6.539,respectively, P<0.05).Boxplots at the genus level showed that Bacteroides,Collinsella,and Rikenellaceae were significantly decreased in abundance at the end of the study, while Blautia,Butyricicoccus,Clostridium,Coprococcus,Dorea,Faecalibacterium,L-Ruminococcus,and Lachnospiraceae were significantly increased.The results of Spearman correlation and multiple regression analysis showed that Faecalibacterium was positively correlated with protein intake(ρ=0.34,P<0.05),but negatively correlated with changes in fasting blood glucose(ρ=-0.56,P<0.05).Rikenecellaceae was negatively correlated with systolic blood pressure(ρ=-0.53,P<0.05).Blautia was negatively correlated with changes in glycosylated hemoglobin(HbA1c),fasting insulin, and HOMA-IR(ρ=-0.53,-0.37 and-0.37,respectively, P<0.05).Butyricimonas and Collinsella were positively correlated with fasting insulin changes(ρ=0.43 and 0.47,respectively, P<0.01) and HOMA-IR changes(ρ=0.50 and 0.46,respectively, P<0.05).Conclusion Changes in microbiota composition with higher α-diversity are detected in GDM patients, as well as associations between metabolic/inflammatory patterns and specific bacterial abundances.

关 键 词：妊娠期糖尿病 肠道菌群 饮食干预 依从性 

分 类 号：R173[医药卫生—妇幼卫生保健]