动态监测脓毒症患者肠道菌群变化与危险分层及预后的关系  

Dynamic monitoring of gut microbiota changes in patients with sepsis and its relationship with risk stratification and prognosis

作　　者：刘文悦 王丽晖 卢清龙 LIU Wenyue;WANG Lihui;LU Qinglong(Cangzhou People's Hospital,Cangzhou Hebei 061000,China)

机构地区：[1]沧州市人民医院,河北沧州061000

出　　处：《中国急救复苏与灾害医学杂志》2023年第8期1046-1050,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：沧州市重点研发计划指导项目(编号:204106012)。

摘　　要：目的探究动态监测脓毒症患者肠道菌群变化与危险分层及预后的关系。方法选取2020年12月—2021年12月沧州市人民医院重症医学科收治的80例脓毒症患者,根据病情严重程度分为脓毒症组(50例)和脓毒症休克组(30例),另选30例健康志愿者作为对照组。脓毒症患者入院第1、3、5、7天留取大便/灌肠后肠道内容物/肛拭子标本,对照组随机留取大便标本,均于留取便标本当日清晨6:00采集空腹静脉血标本。比较三组一般资料、肠道菌群指标[双歧杆菌与肠杆菌的数量比值(B/E)、球杆比]、肠道粘膜损伤标志物[血中二胺氧化酶(DAO)、内毒素(ET)水平及便中短链脂肪酸(SCFAs)浓度],分析肠道菌群与脓毒症危险分层、肠道粘膜损伤标志物的相关性;统计脓毒症患者28 d预后情况,比较不同预后患者入院第1、3、5、7天肠道菌群,分析肠道菌群预测预后的价值。结果脓毒症休克组APACHEⅡ、SOFA评分均高于脓毒症组(P<0.05);入院第1、3、5、7天,B/E、便中SCFAs浓度脓毒症休克组<脓毒症组<对照组,球杆比、血浆DAO、ET水平脓毒症休克组>脓毒症组>对照组(P<0.05);入院第1、3、5、7天,脓毒症休克组与脓毒症组B/E、便中SCFAs浓度均高于第1、3天,球杆比、血浆DAO、ET水平均低于第1、3天(P<0.05)。入院第1天脓毒症患者B/E与血浆DAO、ET水平、病情严重程度、APACHEⅡ、SOFA评分呈负相关,与便中SCFAs浓度呈正相关;球杆比与血浆DAO、ET水平、病情严重程度、APACHEⅡ、SOFA评分呈正相关,与便中SCFAs浓度呈负相关(P<0.05);存活者入院第1、3、5、7天B/E均高于死亡者,球杆比均低于死亡者(P<0.05);入院第7天B/E、球杆比预测脓毒症患者死亡的曲线下面积(AUC)分别为0.739、0.761,联合预测的AUC最大,为0.893。结论脓毒症患者肠道菌群变化与病情危险分层密切相关,动态监测肠道菌群变化能反映病情程度,且在预测预后转归方面具有�Objective To explore the relationship between dynamic monitoring of intestinal flora changes and risk stratification and prognosis in patients with sepsis.Methods 80 patients with sepsis in the Department of Critical Care Medicine of Cangzhou People's Hospital from December 2020 to December 2021 were selected and divided into sepsis group(50 cases)and septic shock group(30 cases)according to the severity of the disease,and another 30 healthy volunteers were selected as the control group.On the 1^(st),3^(rd),5^(th)and 7th day after admission,stool/intestinal contents after enema/anal swab samples were colledted in the septic patients.The control group randomly took stool samples.Fasting venous blood samples were collected at 6:00 AM.on the day when stool samples were taken.The general data,intestinal microflora indicators[the ratio of bifidobacteria to enterobacteria(B/E),the ratio of bulb to stick],intestinal mucosal damage markers[the level of diamine oxidase(DAO)in blood,endotoxin(ET)and the concentration of short chain fatty acids(SCFAs)in the stool]were compared among the three groups,and the correlation between intestinal microflora and sepsis risk stratification,intestinal mucosal damage markers was analyzed.The 28 day prognosis of sepsis patients was counted,and the intestinal flora of patients with different prognosis was compared on the first,third,fifth and seventh days of admission,and the prognostic value of intestinal flora was analyzed.Results The APACHEⅡand SOFA scores in the septic shock group were higher than those in the sepsis group(P<0.05).On the 1^(st),3^(rd),5^(th)and 7th day after admission,the concentration of SCFAs in B/E and stool in septic shock group was lower than that in sepsis group,lower than that in control group,and the ratio of ball to club,the level of plasma DAO and ET in septic shock group was higher than that in sepsis group,higher than that in control group(P<0.05).On the 1^(st),3^(rd),5^(th)and 7th day of admission,the B/E and SCFAs concentrations in the stool of septic

关 键 词：脓毒症 肠道菌群 危险分层 预后 相关性 

分 类 号：R631[医药卫生—外科学]