青海地区2型糖尿病合并肥胖患者肠道菌群特征及其与胰岛素抵抗相关性的研究  

Characteristics of intestinal microbiota in patients with type 2 diabetes mellitus and obesity and its relationship with insulin resistance in Qinghai region

作　　者：李亚楠[1] 孙佳乐 姚勇利[1] 罗玮[1] 王淑琼[1] 宋康[1] 范晓霞[1] 林丽君[1] LI Yanan;SUN Jiale;YAO Yongli(The Second Department of Endocrinology,Qinghai Provincial People's Hospital,Xining 810001,China)

机构地区：[1]青海省人民医院内分泌二科,西宁810001

出　　处：《中国糖尿病杂志》2025年第1期16-22,共7页Chinese Journal of Diabetes

基　　金：2021年度青海省卫健委指导性科研课题(2021-wjzdx-22)。

摘　　要：目的探讨T2DM合并肥胖患者肠道菌群特征及其与IR的相关性。方法选取2022年1月至2023年6月于青海省人民医院内分泌二科收治的新诊断T2DM患者80例,根据是否合并肥胖分为单纯T2DM组及合并肥胖(Obe)组,每组40例,比较两组饮食结构、生化指标和肠道菌群的差异,分析肠道菌群差异与BMI及IR的相关性。结果Obe组BMI、WC、TG、胰岛素抵抗指数(HOMA-IR)及细粮、禽肉蛋、食用油摄入量均高于T2DM组(P<0.05),蔬菜水果摄入量低于T2DM组(P<0.05)。肠道菌群分析显示,两组共有操作分类单元647个,T2DM组特有90个,Obe组特有114个。两组肠道菌群组间差异大于组内(P<0.05),门水平的组内及组间差异最小(P<0.05),两组优势菌群均为拟杆菌、厚壁菌。两组在2门、3纲、5目、8科、17属、15种的相对丰度比较,差异有统计学意义(P<0.05)。拟杆菌、拉氏梭状芽孢杆菌、丁霉菌与BMI呈正相关(P<0.05),双歧杆菌、戴阿利斯特杆菌、链球菌、罗斯氏菌、爱格氏菌、纤毛菌与BMI呈负相关(P<0.05);梭杆菌与HOMA-IR呈正相关(P<0.05)。结论与单纯T2DM患者比较,T2DM合并肥胖患者肠道菌群中有益菌比例下降,致病菌比例升高,可能进一步加重IR,影响T2DM进展。Objective To investigate the characteristics of intestinal microbiota and its relationship with insulin resistance(IR)in patients with type 2 diabetes mellitus(T2DM)and obesity.Methods A total of 80 patients with newly diagnosed T2DM were enrolled in this study from The Second Department of Endocrinology,Qinghai Provincial People's Hospital and divided into simple T2DM group(T2DM,n=40)and T2DM combined with obesity group(Obe,n=40)according to the combination of obesity.The differences of diet structure,biochemical indexes and intestinal flora were compared between the two groups,and the relationship between intestinal flora and BMI,IR was analyzed.Results Compared with the T2DM group,BMI,WC,TG,HOMA-IR,and intake of refined grains,poultry and eggs,and cooking oil were significantly higher(P<0.05),while in take of vegetables and fruits was significantly lower in the Obe group(P<0.05).Microbiota analysis showed that there were 647 OTUs in both groups,90 specific to the T2DM group and 114 specific to the Obe group.The difference of intestinal flora was greater between the two groups than that within the group(P<0.05),and the differences within and between the groups were the least at the phylum level(P<0.05).The dominant flora were Bacteroides and Firmicutes.There were significant differences in the relative abundance of flora in 2 phyla,3 classes,5 orders,8 families,17 genera,and 15 species between the two groups(P<0.05).Bacteroides,Clostridium laprosii and Butylum were positively correlated with BMI(P<0.05),Bifidobacterium,Dialisteria,Streptococcus,Rosesia,Escherichia and Leptotrichia were negatively correlated with BMI(P<0.05).Fusobacterium was positively correlated with HOMA-IR(P<0.05).Conclusions Compared with patients with T2DM alone,patients with T2DM and obesity have a decreased proportion of beneficial bacteria and an increased proportion of pathogenic bacteria in the intestinal flora,which may further aggravate IR and affect the progression of T2DM.

关 键 词：糖尿病 2型 肥胖 肠道菌群 

分 类 号：R589.2[医药卫生—内分泌] R587.2[医药卫生—内科学]