参附注射液对脓毒症急性呼吸窘迫综合征患者肠肺菌群的影响  

Effect of Shenfu injection on intestinal and lung flora in patients with sepsis⁃induced acute respiratory distress syndrome

作　　者：左小淑 江贵军 张迪[1] 李光[1] 詹丽英[1] 邹捍东[1] 夏文芳[1] 高文蔚[1] 宋振举 张召才[3] 王璐[1] ZUO Xiaoshu;JIANG Guijun;ZHANG Di;LI Guang;ZHAN Liying;ZOU Handong;XIA Wenfang;GAO Wenwei;SONG Z henju;ZHANG Zhaocai;WANG Lu(Dept.of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Emergency,Zhongshan Hospital Fudan University&Institute of Emergency Rescue and Critical Care Medicine,Fudan University,Shanghai 200032,China;Dept.of Critical Care Medicine,The Second Affiliated Hospital,Zhejiang University School of Medicine&Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine,Hangzhou 310009,Zhejiang,China)

机构地区：[1]武汉大学人民医院重症医学科,湖北武汉430060 [2]复旦大学附属中山医院急诊科/复旦大学应急救援与急危重症研究所,上海200032 [3]浙江大学医学院附属第二医院重症医学科/浙江省急危重症临床医学研究中心,浙江杭州310009

出　　处：《武汉大学学报(医学版)》2025年第2期166-175,共10页Medical Journal of Wuhan University

基　　金：国家重点研发计划(编号:2021YFC2501800);国家自然科学基金面上项目(编号:82272226);武汉市知识创新专项项目(编号:2023020201010165);武汉大学人民医院交叉创新人才项目(编号:JCRCZN⁃2022⁃017);吴阶平医学基金会重症医学润泽基金。

摘　　要：目的:探讨参附注射液(SF)对脓毒症急性呼吸窘迫综合征(ARDS)患者肠、肺菌群的影响。方法:纳入2022年1—12月武汉大学人民医院22例脓毒症ARDS患者,随机分为常规治疗组(Control组)和SF治疗组(SF组),收集两组患者的肺泡灌洗液(BALF)及粪便,通过16S rRNA及非靶向代谢组学技术,分析SF干预前、后肠道及肺部微生物菌群多样性及代谢产物的改变,寻找差异代谢产物及代谢通路。结果:(1)SF组BALF微生物Alpha多样性较Control组显著改善、Shannon指数变大(P<0.05),提示微生物物种丰富度增加;两组粪便Shannon指数和Beta多样性无显著差异。BALF微生物物种有29.97%来源于粪便,出现了粪便中常见的拟杆菌属。(2)液相色谱-质谱联用(LC-MS/MS)分析显示粪便及BALF在SF处理后,色氨酸代谢通路发生显著变化(P<0.05)。粪便KEGG富集分析发现,色氨酸代谢和5-羟基吲哚乙酸盐均被下调(P<0.05)。结论:对于脓毒症ARDS患者,SF可丰富其BALF及粪便中菌群多样性,并参与色氨酸代谢途径,本研究为后续深入研究SF参与ARDS肠肺轴的作用机制提供一定参考和依据。Objective:To explore the effect of Shenfu injection(SF)on intestinal and lung flora in patients with sepsis-induced acute respiratory distress syndrome(ARDS).Methods:From January to Decem-ber 2022,twenty-two patients with sepsis-induced ARDS were enrolled at Renmin Hospital of Wu-han University.The patients were randomly divided into the conventional treatment group(control group)and the Shenfu injection treatment group(SF group).Bronchoalveolar lavage fluid(BALF)and fecal samples were collected from both groups.16S rRNA and non-targeted metabolomics technolo-gies were used to analyze the changes in microbial flora diversity and metabolites in the intestine and lungs before and after SF intervention,and to identify differential metabolites and metabolic path-ways.Results:(1)The BALF microbial Alpha diversity of the SF group was significantly improved as compared with that of the control group,and the Shannon index became larger(P<0.05),indicat-ing that the richness of microbial species increased;there was no significant difference in fecal Shannon index and Beta diversity between the two groups.29.97%of BALF microbial species originated from feces,and Bacteroidetes,which is common in feces,appeared in BALF.(2)LC-MS/MS showed that the tryptophan metabolism pathway in feces and BALF changed significantly after SF treatment(P<0.05).Fecal KEGG enrichment analysis found that the expression of metabolite tryptophan and 5-hydroxyindoleacetate were both down-regulated(P<0.05).Conclusion:Shenfu Injection has a ten-dency to enrich the diversity of BALF and fecal flora in patients with sepsis-induced ARDS,and par-ticipates in the tryptophan metabolic pathway,which provides a certain reference and basis for subse-quent in-depth research on the mechanism of Shenfu Injection in the gut-lung axis of ARDS.

关 键 词：脓毒症 急性呼吸窘迫综合征 肠道菌群 肺泡灌洗液 代谢组学 

分 类 号：R453.9[医药卫生—治疗学]