老年维持性血液透析患者肠道菌群分布与营养状态研究  

Relationship between gut microbiota distribution and nutritional status in elderly patients with maintenance hemodialysis

作　　者：向平 李云平[2] 胡小容 尤小英 屈小燕 Xiang Ping;Li Yunping;Hu Xiaorong;You Xiaoying;Qu Xiaoyan(Hemodialysis Room,Affiliated Dazu's Hospital of Chongqing Medical University,Chongqing 402360,China;Hemodialysis Room,Fifth People's Hospital of Chongqing,Chongqing 400062,China)

机构地区：[1]重庆医科大学附属大足医院血液透析室,重庆402360 [2]重庆市第五人民医院血透室,重庆400062

出　　处：《中华老年多器官疾病杂志》2025年第1期45-49,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：重庆市科技局科研基金(2022L027);重庆市科技计划项目(DZKJ2021ACC1025)。

摘　　要：目的探讨老年维持性血液透析(MHD)患者肠道菌群分布与营养状态和生活质量的相关性。方法选取2021年2月至2023年2月于重庆医科大学附属大足医院接受规律MHD治疗的156例慢性肾功能衰竭患者为研究对象。采集患者新鲜粪便标本,根据肠道菌群涂片检查结果将其分为菌群正常组(n=53)和菌群失衡组(n=103)。经16S rDNA实时荧光定量聚合酶链式反应法检测并比较两组患者粪便双歧杆菌、乳酸杆菌、大肠杆菌以及肠球菌定量分析结果。收集患者营养状况指标,包括体质量指数(BMI)、血红蛋白、白蛋白(Alb)以及微型营养评价量表(MNA)评分。采用肾脏疾病生存质量简表1.3评估患者生存质量。采用Pearson相关性分析评估MHD患者肠道菌群定量检测结果与营养状态和生活质量的相关性。结果156例MHD患者中肠道菌群正常者53例(33.97%),Ⅰ度菌群失衡者67例(42.95%),Ⅱ度菌群失衡者31例(19.87%),Ⅲ度菌群失衡者5例(3.21%)。菌群失衡组双歧杆菌[(6.73±1.09)和(9.45±1.26)lg CFU/g]及乳酸杆菌数量[(7.14±0.86)和(9.92±1.03)lg CFU/g]显著低于正常组,大肠杆菌[(8.75±1.12)和(8.06±0.94)lg CFU/g]及肠球菌数量[(9.68±1.05)和(9.13±1.27)lg CFU/g]显著高于正常组,差异均有统计学意义(均P<0.05)。菌群失衡组BMI[(20.34±3.51)和(21.68±3.27)kg/m 2]、ALB[(28.53±4.29)和(31.47±4.05)g/L]、MNA评分[(21.36±4.27)和(25.14±3.98)分]及36条目简明健康状况调查问卷(SF-36)评分[(52.64±9.13)和(58.71±9.48)分]显著低于正常组,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,BMI、Alb、MNA评分和SF-36评分与肠道双歧杆菌(r=0.417,0.309,0.461,0.382;P<0.05)和乳酸杆菌(r=0.463,0.357,0.507,0.417;P<0.001)数量均呈正相关,与肠道大肠杆菌(r=-0.389,-0.426,-0.435,-0.354;P<0.001)和肠球菌(r=-0.326,-0.512,-0.548,-0.496;P<0.001)数量均呈负相关。结论老年MHD患者营养状态和生活质量较差,且两者均与肠道菌群Objective To explore the relationship between gut microbiota distribution and the nutritional status and quality of life in elderly patients undergoing maintenance hemodialysis(MHD).Methods From February 2021 to February 2023,156 chronic renal failure patients who received regular MHD in the Affiliated Dazu's Hospital of Chongqing Medical University were selected as the study subjects.Fresh fecal samples were collected,and the patients were divided into a normal group(n=53)and a dysbiosis group(n=103)according to the results of gut microbiota smear examination.The real-time fluorescence quantitative polymerase chain reaction(PCR)of the bacterial 16S rDNA gen was performed,and the two groups were compared in the quantitative results of fecal Bifidobacterum,Lactobacillus,Escherichia coli,and Enterococcus.The nutritional status indicators,including body mass index(BMI),hemoglobin(Hb),albumin(Alb),and scores on mini-nutritional assessment(MNA),were collected for both groups.The quality of life was evaluated using kidney disease quality of life short form(KDQOL-SF)1.3.Pearson correlation analysis was conducted to analyze the correlation between quantitative findings of gut microbiota and the nutritional status and quality of life in MHD patients.Results Among 156 MHD patients,53(33.97%)were of normal gut microbiota,67(42.95%)of Degree Ⅰ gut microbiota dysbiosis,31(19.87%)of DegreeⅡgut microbiota dysbiosis,and 5(3.21%)of Degree Ⅲ gut microbiota dysbiosis.The Bifidobacterium count[(6.73±1.09)vs(9.45±1.26)lg CFU/g]and Lactobacillus count[(7.14±0.86)vs(9.92±1.03)lg CFU/g]in the dysbiosis group were lower,while the Escherichia coli count[(8.75±1.12)vs(8.06±0.94)lg CFU/g]and Enterococcus count[(9.68±1.05)vs(9.13±1.27)lg CFU/g]were higher than those in the normal group,with all differences being statistically significant(P<0.05 for all).The BMI[(20.34±3.51)vs(21.68±3.27)kg/m 2],Alb[(28.53±4.29)vs(31.47±4.05)g/L],MNA score[(21.36±4.27)vs(25.14±3.98)points]and 36-item short-form(SF-36)score[(52.64±9.13)vs(

关 键 词：老年人 维持性血液透析 肠道菌群 营养状态 生活质量 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学] R592[医药卫生—临床医学]