高膳食纤维低血糖生成指数饮食对2型糖尿病患者肠道菌群和血糖的影响研究

Effect of High Fiber and Low Glycemic Index Diet on Gut Microflora and Blood Glucose in Patients With Type 2 Diabetes Mellitus

目的研究高膳食纤维低血糖生成指数(GI)饮食对2型糖尿病(T2DM)患者肠道菌群和血糖的影响。方法选取2014年1月—2015年12月新疆医科大学附属中医医院治疗的T2DM患者100例为研究对象,采用随机数字表法将患者分为对照组和干预组,各50例,于同期选取本院健康体检者50例为健康组。对照组患者接受糖尿病饮食、运动治疗,并口服降糖药。干预组在上述治疗的基础上,给予高膳食纤维低GI饮食。干预持续6个月。采用24 h食物回顾法及食物称重法评估两组患者干预前后的能量及营养摄入量。对照组和干预组于干预前后,健康组于体检时留取粪便标本,提取粪便菌群基因组DNA。设计总细菌、球形梭菌类、柔嫩梭菌类、拟杆菌属、双歧杆菌属、乳酸杆菌属、肠球菌属、大肠埃希菌属特异性引物,并在BLAST基因库内对比引物特异性。对照组和干预组患者于干预前后抽取空腹静脉血进行生化检查,记录患者血脂、血糖、胰岛素水平。结果在扣除干预前的影响后,干预组能量、脂肪、碳水化合物摄入量低于对照组,蛋白质摄入量高于对照组,差异均有统计学意义(P<0.05)。在扣除干预前的影响后,干预组柔嫩梭菌类、肠球菌属、大肠埃希菌属低于对照组,拟杆菌属、双歧杆菌属、乳酸杆菌属高于对照组,差异均有统计学意义(P<0.05)。干预后干预组柔嫩梭菌类、肠球菌属、大肠埃希菌属高于健康组,拟杆菌属、双歧杆菌属、乳酸杆菌属低于健康组,差异均有统计学意义(P<0.05)。在扣除干预前的影响后,干预组总胆固醇(TC)、三酰甘油(TG)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)水平、胰岛素抵抗指数(HOMA-IR)低于对照组,低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平高于对照组,差异均有统计学意义(P<0.05)。结论高膳食纤维低GI饮食可以有效改善T2DM患者肠道菌群失调,并一定程度上改善血脂、血糖等代谢紊乱。

Objective To study the effect of high fibre and low glycemic index diet on the gut microflora and blood glucose in patients with T2 DM. Methods From January 2014 to December 2015,100 T2 DM patients were enrolled from the Traditional Chinese Medical Hospital of Xinjiang Medical University. Using random number table method, the patients were divided into 2 groups： control group（ n = 50） and intervention group（ n = 50）. In the same period,50 healthy people were enrolled as healthy group. Patients in control group received dietary and exercise therapy and oral administration of drugs for reducing blood glucose. Based on the above therapy,intervention group also received high fibre and low glycemic index diet.The intervention lasted for 6 months. Energy intake and nutrient intake of the two groups were evaluated by 24 h food retrospective method and food weighing method before and after intervention. Feces samples were taken from control group and intervention group before and after intervention and from healthy group in physical examination,and genome DNA of microflora in feces was extracted. The primers of total bacteria,spherical clostridium group,clostridium leptum group,bacteroides,bifidobacterium,lactobacillus,enterococcus,and escherichia coli were designed and compared in BLAST genbank. The level of blood lipid,glucose and insulinwere investigated before and after intervention between control group and intervention group. Results After deducting the influence before intervention,intervention group was lower than control group in the intake of energy, fat and carbohydrate,and was higher than control group in the intake of protein（ P 0. 05）. After deducting the influence before intervention,intervention group had less clostridium leptum group, enterococcus and escherichia coli and more bacteroides,bifidobacterium and lactobacillus than control group（ P 0. 05）. After intervention,intervention group had more clostridium leptum group,enterococcus and escherichia coli and less bacteroides,bifidobacterium and lactobacillus than control group（ P 0. 05）. After deducting the influence before intervention,intervention group had lower TC,TG,FPG,Hb A1 c,FINS levels and HOMA-IR and higher LDL-C and HDL-C levels than control group（ P 0. 05）. Conclusion High fibre and low glycemic index diet can effectively improve the alteration of intestinal flora of patients with T2DM,and improve metabolic disturbances like hyperglycemia some extent.