肾草酸钙结石湿热体质、痰湿体质与肠道菌群相关性的临床研究  

Clinical study on the relationship between kidney calcium oxalate stones,damp-heat constitution,phlegm-dampness constitution and intestinal flora

作　　者：金振华 张继康 陈凯华 许坤 孙梦伟 卢子杰 JIN Zhenhua;ZHANG Jikang;CHEN Kaihua;XU Kun;SUN Mengwei;LU Zijie(Jiangsu Province Hospital of Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029;The Second Affiliated Hospital of Nanjing University of Chinese Medicine)

机构地区：[1]南京中医药大学附属医院/江苏省中医院,南京210029 [2]南京中医药大学第二附属医院

出　　处：《现代中医临床》2024年第4期14-18,共5页Modern Chinese Clinical Medicine

基　　金：江苏省中医药管理局(No.RC201902)。

摘　　要：目的探讨肾草酸钙结石湿热体质、痰湿体质与肠道菌群间相关性。方法将60例肾草酸钙结石复发患者,分为湿热体质30例,痰湿体质30例。观察肠道菌群高通量测序结果;24 h尿液草酸、枸橼酸含量。结果2组肠道菌群高通量测序结果显示,2组样本共得到3790个操作分类单元(OTUs),其中,湿热体质组和痰湿体质组OTUs数目分别为2394个和2289个。采用线性判别式分析差异菌群结果显示,湿热体质组菌群以丙型变形菌纲、肠杆菌科、肠杆菌目、变形菌门为主要特征差异细菌菌类,痰湿体质组菌群以疣微菌科、氏菌属、粪芽孢菌属、甲型变形菌纲、柔嫩梭菌为主要特征差异细菌菌类。通过OTUs代表性序列的物种分类学分析,与湿热体质组相比,痰湿体质组在门、纲、目分类水平上菌群丰度呈升高的分别为变形菌门、丙型变形菌纲和肠杆菌目;在科水平上,具有丰度增高的肠杆菌科和消化链球菌科,以及丰度显著减低的疣微菌科;在属水平上,具有丰度增高的埃希氏杆菌属;在种水平上,具有丰度降低的单形拟杆菌。2组肠道菌群菌种丰度比较显示,痰湿体质组中变形菌门、肠杆菌目丰度高于湿热体质组,厚壁菌门、疣微菌科丰度低于湿热体质组,差异均有统计学意义(P<0.05)。2组治疗前,湿热体质组24 h尿液中草酸和枸橼酸水平均高于痰湿体质组,差异均具有统计学意义(P<0.05)。湿热体质组治疗后草酸含量较本组治疗前降低,差异具有统计学意义(P<0.05);痰湿体质组治疗后草酸含量较本组治疗前降低,枸橼酸含量较本组治疗前升高,差异均具有统计学意义(P<0.05)。结论肾草酸钙结石湿热体质、痰湿体质与肠道菌群间有一定相关性,中医辨证治疗可改善肾草酸钙结石高危代谢因素。Objective To investigate the relationship between kidney calcium oxalate stones,damp-heat constitution,phlegm-dampness constitution,and intestinal flora.Methods 60 patients with recurrent renal calcium oxalate stones were divided into two groups:30 patients with a damp-heat constitution and 30 patients with a phlegm-dampness constitution.High-throughput sequencing of intestinal flora was performed,and 24-hour urine oxalic acid and citric acid levels were measured.Results The high-throughput sequencing of intestinal flora identified 3,790 operational taxonomic units(OTUs)across both groups.The damp-heat group had 2,394 OTUs,while the phlegm-dampness group had 2,289.Linear discriminant analysis revealed that the damp-heat group’s flora was characterized by Proteobacteria C,Enterobacteriaceae,Enterobacteriales,and Proteobacteria,whereas the phlegm-dampness group’s flora was characterized by Verrucomicrobiaceae,Bacteroides,Coprococcus,Proteobacteria A,and Clostridium teniculum.Comparative taxonomic analysis of OTU representative sequences showed increased abundance in the phlegm-dampness group at the phylum,class,and order levels,particularly Proteobacteria,Proteobacteria C,and Enterobacteriales.At the family level,Enterobacteriaceae and Peptostreptococcaceae were more abundant,while Verrucomicrobiaceae were significantly less abundant in the phlegm-dampness group.Genus-level analysis showed increased Escherichia and decreased Bacteroides abundance.Comparison of intestinal flora abundance indicated higher levels of Proteobacteria and Enterobacteriales in the phlegm-dampness group and higher levels of Firmicutes and Verrucomicrobiaceae in the damp-heat group,with statistically significant differences(P<0.05).Before treatment,24-hour urine oxalic acid and citric acid levels were higher in the damp-heat group than in the phlegm-dampness group(P<0.05).Post-treatment,the damp-heat group showed a significant reduction in oxalic acid levels(P<0.05),while the phlegm-dampness group showed a significant reduction in oxalic

关 键 词：肾草酸钙结石 湿热体质 痰湿体质 肠道菌群 草酸 枸橼酸 

分 类 号：R259[医药卫生—中西医结合]