血清内毒素、D-乳酸与慢性肾脏病肠源性尿毒症毒素的相关性研究  

Correlation between Serum Endotoxin, D-lactate and Enterogenic Uremic Toxins in Chronic Kidney Disease

作　　者：张倩 李同侠[1] 李翔宇 刘武 周一 黄雪莹 张宁[1] ZHANG Qian;LI Tongxia;LI Xiangyu(Wangjing Hospital,Chinese Academy of Traditional Chinses Medicine,Beijing 100102,China)

机构地区：[1]中国中医科学院望京医院,北京100102

出　　处：《医学研究杂志》2024年第10期134-139,共6页Journal of Medical Research

基　　金：北京市中医药科技发展基金资助项目(BJZYYB-2023-43);中国中医科学院望京医院高水平中医医院建设项目(WJZJ-202308);中国中医科学院科技创新工程重大攻关项目(CI2021A01609)。

摘　　要：目的 研究肠道屏障指标血清内毒素、D-乳酸与慢性肾脏病(chronic kidney disease, CKD)患者肠源性尿毒症毒素包括硫酸吲哚酚(indoxyl sulfate, IS)、尿素氮的相关性。方法 选取2019年4月~2021年8月中国中医科学院望京医院肾病内分泌科门诊及住院患者共260例CKD患者,按照CKD分期分为CKD3期组(n=51)、CKD4期组(n=130)、CKD5期组(n=79)。记录患者年龄、性别、病程、既往病史,检测患者血清IS、尿素氮、血清内毒素、D-乳酸、血肌酐,估算肾小球滤过率(estimated glomerular filtration rate, eGFR),留取患者粪便,检测大肠杆菌、双歧杆菌菌落水平。分析血清内毒素及D-乳酸与肠源性尿毒症毒素的相关性。结果 一般资料比较,3组在年龄、性别、病程、既往合并糖尿病、双歧杆菌水平方面比较,差异无统计学意义(P>0.05),在既往合并高血压、冠心病、IS、血肌酐、尿素氮、eGFR、血清内毒素、D-乳酸、大肠杆菌方面比较,差异有统计学意义(P<0.05)。相关性分析:Spearman分析结果显示,血清内毒素、D-乳酸均与IS、尿素氮、血肌酐呈显著正相关(P<0.05),与eGFR呈负相关(P<0.05);Pearson分析结果显示,血清内毒素、D-乳酸均与大肠杆菌、双歧杆菌呈显著正相关(P<0.05)。多因素线性回归分析:IS是血清内毒素的独立影响因素(P<0.001),IS、尿素氮是D-乳酸的独立影响因素(P<0.05)。结论 CKD患者中血清内毒素及D-乳酸水平升高与肠源性尿毒症毒素相关。Objective To study the correlation between two indicators of the intestinal barrier(i.e.,serum endotoxins and D-lactate)and enterogenic uremic toxins,including indoxyl sulfate(IS)and urea nitrogen,in patients with chronic kidney disease(CKD).Methods A total of 260 CKD patients were selected from outpatients and inpatients of the Department of Nephrology and Endocrinology,Wangjing Hospital,China Academy of Traditional Chinese Medicine,from April 2019 to August 2021,and were divided into the CKD stage 3 group(n=51),the CKD stage 4 group(n=130),and the CKD stage 5 group(n=79),according to CKD stage.Patients′age,gender,disease duration,and past medical history were recorded.Serum IS,urea nitrogen,serum endotoxin,D-lactate,and blood creatinine were detected.The estimated glomerular filtration rate(eGFR)was calculated.Patients′faeces were retained to detect the levels of Escherichia coli and Bifidobacterium bifidum colonies.The correlation between serum endotoxin and D-lactate and enterogenic uremic toxins was analyzed.Results Comparison of general data:There were no significant differences in age,gender,course of disease,previous diabetes mellitus,and bifidobacteria levels between the three groups(P>0.05),but there were significant differences in pre-existing hypertension and coronary heart disease,IS,serum creatinine,urea nitrogen,eGFR,serum endotoxin,D-lactate acid,and E.coli(P<0.05).Correlation analysis:Spearman analysis showed that serum endotoxin and D-lactate were significantly positively correlated with IS,urea nitrogen,and serum creatinine(P<0.05),and negatively correlated with eGFR(P<0.05).The results of Pearson analysis showed that serum endotoxin and D-lactate were significantly positively correlated with E.coli and Bifidobacterium(P<0.05).Multivariate linear regression analysis showed that IS was the independent influencing factor of serum endotoxin(P<0.001)and IS and urea nitrogen were the independent influencing factors of D-lactate(P<0.05).Conclusion Elevated serum endotoxin and D-lactate levels in

关 键 词：硫酸吲哚酚 肠道屏障 慢性肾脏病 血清内毒素 D-乳酸 

分 类 号：R589[医药卫生—内分泌]