类风湿关节炎合并肺间质性病变患者肠道菌群特征及影响因素分析  

Analysis of intestinal flora characteristics and influencing factors in patients with rheumatoid arthritis complicated with interstitial lung disease

作　　者：陈庆娜 刘彦洁 李良霄[2] 马利娜 肖冉冉 CHEN Qingna;LIU Yanjie;LI Liangxiao;MA Lina;XIAO Ranran(Department of Infectious Diseases,Shijiazhuang People's Hospital,Shijiazhuang 050031,China;Department of Infectious Diseases,the First Hospital of Handan,Handan 056007,China;Department of Urology,the Fourth Hospital of Handan,Handan 056200,China)

机构地区：[1]石家庄市人民医院感染性疾病一科,石家庄050031 [2]邯郸市第一医院感染性疾病科,邯郸056007 [3]邯郸市第四医院泌尿外科,邯郸056200

出　　处：《中国免疫学杂志》2024年第11期2361-2367,2372,共8页Chinese Journal of Immunology

基　　金：石家庄市科学技术研究与发展计划(211460753)。

摘　　要：目的:探究类风湿关节炎合并肺间质性病变(RA-ILD)患者肠道菌群特征,分析其影响因素,并探究不同治疗方法对RA-ILD患者肠道菌群的改善情况。方法:选择2021年6月至2022年6月于石家庄市人民医院就诊的100例RA-ILD患者为研究对象,另选择同期石家庄市第一医院门诊健康体检者100例为健康组。对两组患者肠道菌群进行高通量测序,比较两组OTU菌群丰度、α-多样性、β-多样性、菌群分布及LEfSe差异分析。采用随机数字表法将100例RA-ILD患者分为A组(n=50)和B组(n=50),A组给予来氟米特+尼达尼布或吡非尼酮治疗,B组给予来氟米特+尼达尼布或吡非尼酮+双歧杆菌三联活菌,分析两组治疗后的肠道菌群改善情况。相关性分析判断RA-ILD患者肠道菌群变化与其临床特征及指标的相关性。结果:RA-ILD患者OTU菌群丰度、α-多样性、β-多样性均低于健康人群。RA-ILD组Intestinibacter菌属丰度高于健康组,乳杆菌属(Lactobacillus)、大肠志贺氏杆菌(Escherichia shigella)、克雷伯氏菌属(Klebsiella)、Candidatus Saccharimonas菌属、Odoribacter菌属以及肠球菌属(Enterococcus)丰度均低于健康组。治疗后A组和B组菌群结构均有所改善,B组更接近健康人群,疗效显著优于A组。Intestinibacter菌属细菌水平与患者年龄、RA病程、DAS28、CRP、RF、KL-6呈显著正相关(P<0.05),与DLCO呈显著负相关(P<0.05);乳杆菌属细菌水平与RA病程、DAS28、CRP、RF、IL-6呈显著负相关(P<0.05),与VC呈显著正相关(P<0.05);大肠志贺氏杆菌水平与RA病程、ILD病程、DAS28、ESR、RF、TNF-α呈显著负相关(P<0.05);克雷伯氏菌属细菌水平与VC和DLCO呈显著正相关(P<0.05);Candidatus Saccharimonas菌属细菌水平与DAS28、ESR、CRP、RF、IL-6、TNF-α呈显著负相关(P<0.05),与DLCO呈显著正相关(P<0.05);Odoribacter菌属细菌水平与DAS28、CRP、RF、IL-6、KL-6呈显著负相关(P<0.05),与VC呈显著正相关(P<0.05);肠球菌属细菌�Objective:To explore characteristics of intestinal flora in patients with rheumatoid arthritis complicated with inter-stitial lung disease(RA-ILD),to analyze its influencing factors,and to explore improvement of intestinal flora in patients with RA-ILD by different treatment methods.Methods:A total of 100 patients with RA-ILD who visited Shijiazhuang People's Hospital from June 2021 to June 2022 were selected as research objects,and 100 healthy patients in Shijiazhuang People's Hospital during same pe-riod were selected as healthy group.High throughput sequencing was performed on intestinal flora of two groups,OTU flora abundance andα-Diversity,β-diversity,flora distribution and LEfSe difference were analyzed.Another 100 patients with RA-ILD were randomly divided into group A(n=50)and group B(n=50).Group A was treated with leflunomide+nidanib or pifenidone,and group B was treated with leflunomide+nidanib or pifenidone+bifidobacterium triad.Improvement of intestinal flora in two groups after treatment was analyzed.Correlation analysis was used to determine correlation between changes of intestinal flora and clinical characteristics and indicators in RA-ILD patients.Results:OTU flora abundance,α-diversity andβ-diversity in RA-ILD patients were lower than that of healthy people.Abundance of Intestinibacter in RA-ILD group was higher than that in healthy group,and abundance of Lactobacillus,Escherichia coli,Klebsiella,Candidatus saccharimonas,Odoribacter and Enterococcus in RA-ILD group were lower than that in healthy group.After treatment,flora structure of group A and group B was improved.Group B was closer to healthy population,and cu-rative effect was significantly better than that of group A.Integinibacter bacteria level was positively correlated with age,RA course,DAS28,CRP,RF and KL-6(P<0.05),and negatively correlated with DLCO(P<0.05).Lactobacillus level was negatively correlated with course of RA,DAS28,CRP,RF,IL-6(P<0.05),and positively correlated with VC(P<0.05);Shigella coli level was negtively correla

关 键 词：类风湿关节炎 肺间质性病变 肠道菌群 影响因素 

分 类 号：R392[医药卫生—免疫学]