老年重症肺炎患者的肠道菌群特征研究  

Characteristics of gut microbiota in elderly patients with severe pneumonia

作　　者：YU Steven 周昊[1,2] 蒋娟 胡新月[1,2] 李窕 李园园[1,2] YU Steven;ZHOU Hao;JIANG Juan;HU Xinyue;LI Tiao;LI Yuanyuan(Department of Respiratory and Critical Care Medicine,Xiangya Center for Respiratory Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸与危重症医学科湘雅医院呼吸中心,湖南长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008

出　　处：《中国感染控制杂志》2025年第3期361-371,共11页Chinese Journal of Infection Control

基　　金：医学科技人才培养计划—高通量测序技术在感染性疾病中的临床应用研究专项(MTP2022A002);呼吸与危重症医学科-国家临床重点专科建设项目(Z047-02);2023年度国家老年疾病临床医学研究中心临床研究基金(2023LNJJ08);湖南省卫健委高层次人才支持计划(2100499)。

摘　　要：目的总结与分析老年重症肺炎患者的主要临床特点、肠道菌群特征及组成变化,并进一步探究老年重症肺炎患者肠道特征与重症肺炎病原学之间的潜在相关性。方法选取长沙市某三级教学医院呼吸危重症监护病房中重症肺炎患者为研究对象,≥65岁为老年重症肺炎组,<65岁为非老年重症肺炎组。通过临床特征及下呼吸道分泌物病原学检测,将老年重症肺炎组进一步分为肺部细菌感染组与肺部真菌感染组,肺部细菌感染组根据革兰染色结果细分为革兰阳性菌组与革兰阴性菌组。收集其临床资料,并采集其入院后24 h内的粪便标本进行16S rRNA测序检测,比较两组患者肠道菌群特征差异,分析老年重症肺炎组患者临床特征与两组差异菌群丰度的相关性。随后,分析感染不同类型病原体的老年重症肺炎组患者的肠道菌群特征。结果肠道菌群分析结果提示,老年重症肺炎组与非老年重症肺炎组患者肠道微生物α和β多样性指数差异无统计学意义(均P>0.05);线性判别分析(LEFSe)结果发现,与非老年重症肺炎组患者相比,老年重症肺炎组患者肠道菌群中机会性致病菌假单胞菌目、莫拉氏菌科以及不动杆菌属的相对丰度增高(均P<0.05);两组患者部分肠道差异菌群与老年重症肺炎组患者临床指标具有相关性(均P<0.05)。β多样性分析(主坐标分析)结合Anosim分析发现,老年重症肺炎组患者中,真菌感染组与细菌感染组患者肠道菌群群落结构差异有统计学意义(R=0.149,P=0.02);相比于真菌感染组,细菌感染组患者中疣微菌目、柯林斯菌属以及阿克曼菌属等益生菌及机会致病菌克雷伯菌属的丰度明显减少(均P<0.05)。结论与非老年重症肺炎患者相比,老年重症肺炎患者肠道菌群处于失调状态,肠道内致病菌丰度增加。两组患者肠道差异菌群与老年重症肺炎患者的部分感染指标以及器官功能相关指标�Objective To summarize and analyze the main clinical characteristics,feature and composition changes of gut microbiota in elderly patients with severe pneumonia,and to further explore the potential correlation between the gut characteristics and the etiology of severe pneumonia in elderly patients.Methods Patients with severe pneumonia admitted to the respiratory intensive care unit of a tertiary teaching hospital in Changsha were selected as the research subjects.Patients aged≥65 years were assigned to the elderly severe pneumonia group,while those aged<65 years were assigned to the non-elderly severe pneumonia group.Based on clinical characteristics and pathogen detection of lower respiratory secretion,the elderly severe pneumonia group was further divided into a pulmonary bacterial infection group and a pulmonary fungal infection group.The pulmonary bacterial infection group was subdivided into Gram-positive bacteria group and Gram-negative bacteria group based on Gram-staining results.Clinical data of patients were collected,and fecal specimens within 24 hours after admission were obtained for 16S rRNA sequencing.Differences in gut microbiota characteristics between two groups of patients were compared,and the correlation between clinical characteristics of patients in the elderly severe pneumonia group and the abundance of differential microbiota was analyzed.Subsequently,the gut microbiota characteristics of elderly patients in severe pneumonia group infected by different pathogens were analyzed.Results Gut microbiota analysis showed no significant statistical differences inα-andβ-diversity indicices between patients in the elderly and non-elderly severe pneumonia groups(both P>0.05).Linear discriminant analysis effect size(LEFSe)analysis indicated that,compared with patients in the non-elderly severe pneumonia group,the relative abundance of opportunistic pathogens,including Pseudomonadales,Moraxellaceae,and Acinetobacter,was significantly higher in patients in the elderly severe pneumonia group(all P<

关 键 词：重症肺炎 老年患者 肠道菌群 16S rRNA 

分 类 号：R181.32[医药卫生—流行病学] R563.1[医药卫生—公共卫生与预防医学]