鼻饲置管深度对重型颅脑损伤患者肠道菌群的影响

Effects of different feeding methods on gut microbiota in patients with severe traumatic brain injury

目的探讨鼻饲置管深度对重型颅脑损伤患者肠道菌群的影响。方法 2015年6月至2016年6月收治符合标准的重型颅脑损伤126例,根据鼻饲插管深度分为鼻胃管组(66例)和鼻肠管组(60例)。利用高通量实验测序分析患者肠道菌群的分布和多样性,采用Logistic回归分析检验院内感染与肠道菌群的关系。结果与鼻胃管组相比,鼻肠管组肠道菌群数量明显增多(40 310.6±1 115.7 vs 34 473.7±883.4;P<0.05),双歧杆菌属相对丰度也明显增高[(44.8±9.7)‰vs(11.8±10.6)‰;P<0.05],而肠球菌属相对丰度明显降低[(7.7±5.5)‰vs(4.3±9.5)‰;P<0.05],艰难梭菌属相对丰度也明显降低[(26.5±4.5)‰vs(2.9±1.1)‰;P<0.05]。Logistics回归分析显示菌群多样性增多是造成院内肺炎的危险因素(OR=208.580,95%CI为14.877~2924.311;P=0.000),而菌群的种类数(OR=0.0004,95%CI为0.000~0.163;P=0.010)和双歧杆菌属的增多是抑制胃肠道感染发生的重要因素(OR=0.006,95%CI为0.000~0.248;P=0.007)。结论对重型颅脑损伤,鼻肠管喂养可导致肠道内细菌种类数和双歧杆菌属相对丰度的增多,在不增加菌群多样性的前提下,细菌总种类数目和双歧杆菌的增多是预防患者发生院内胃肠道感染的保护因素。

Objective To compare the characteristics of gut microbiota between the patients with severe traumatic brain injury （sTBI） receiving small intestinal feeling and ones receiving gastric feeding. Methods One hundred and twenty-six patients with sTBI were divided into two groups, i.e. group A in which 66 patients received gastric feeding and group B in which 60 received small intestinal feeding. The distribution and diversity of gut microbiota were detected by Illumina sequencing in both the groups. The factors related to the bacterial flora were analyzed in the patients with nosocomial infection. Results The total bacterial species number and Bifidobacterium abundance were significantly more in group B than that in group A （P〈0.05）. However, Enterococcus and Clostridium abundances were significantly higher in group A than that in group B （P〈0.05）. Logistic regression analysis showed that a more complex diversity of gut microbiota was the risk factor of the nosocomial pneumonia. The increases in the total bacterial species number and Bifidobacterium abundance were the important factors to inhibit the nosocomial gastrointestinal tract infection （P〈0.05） in the patients with STBI. Conclusions The increases in the total bacterial species number and Bifidobacterium abundance can be produced by small intestinal feeding in the patients with sTBI. Under the circumstance of not increasing the microbiota diversity, the increases in total bacterial species number and Bifidobacterium abundance were the protective factors for nosocomial gastrointestinal tract infections in the patients with STBI.