腹泻型、便秘型及混合型肠易激综合征患者肠道菌群的差异性比较

Comparison of intestinal flora in patients with diarrhea type, constipation type, and mixed type irritable bowel syndrome

目的比较腹泻型、便秘型及混合型肠易激综合征（IBS）患者肠道菌群的差异性。方法选取本院消化内科腹泻型、便秘型、混合型IBS患者各40例，同时选取同期在本院体检的健康者40例作为对照，比较四组患者肠道菌群差异。结果对照组肠道菌群密集度Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为0％、10％、35％、55％，腹泻组10％、60％、25％、5％，便秘组5％、25％、35％、35％，混合组5％、20％、40％、35％，腹泻组肠道菌群密集度与其他三组比较差异有统计学意义（P〈0．05）；对照组肠道菌群多样性Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级分别为5％、20％、65％、10％，腹泻组15％、50％、15％、20％，便秘组10％、30％、45％、15％，混合组10％、45％、30％、15％，腹泻组、混合组与对照组比较差异有统计学意义（P〈0．05），腹泻组和便秘组比较差异有统计学意义（P〈0．05）；对照组肠杆菌、肠球菌、双歧杆菌、乳杆菌、拟杆菌分别为（8．18±0．68）、6．74±0．89）、（8．93±0．87）、（7．05±1．07）、（8．42±0．64）logCFU／g湿便，B／E值为（1．08±0．15），而腹泻组分别为（8．81±1．04）、（6．40±0．87）、（8．26±0．94）、（6．32±1．05）、（8．62±0．62）logCFU／g湿便和（0．95±0．14），便秘组（8．24±0．87）、（6．58±1．05）、（8．54±1．04）、（6．48±0．84）、（9．24±0．64）logCFU／g湿便和（1．04±0．18），混合组（8．83±1．12）、（6．78±1．19）、（8．62±0．91）、（6．21±1．04）、（8．48±0．69）logCFU／g湿便和（0．98±0．16），与对照组比较，IBS组肠杆菌、拟杆菌增多（P〈0．05），双歧杆菌、乳杆菌和B／E值减少（P〈0．05），肠球菌差异不显著（P〉0．05）。结论肠易激综合征患者均存在不同程度肠道菌群紊乱，其中以腹泻型IBS菌群失调最为严重，肠道菌群是影响IBS发生的因素之一。

Objective To compare the intestinal flora in patients with diarrhea type, constipation type, and mixed type irritable bowel syndrome （IBS）. Methods 40 patients with diarrhea type IBS, 40 patients with constipation type IBS, and 40 patients with mixed type IBS in our hospital were studied, and 40 healthy persons were selected as control group at the same time. The intestinal flora were compared among the four groups. Results Grade I , II ,llI, IV intestinal flora intensity accounted for 0%, 10%, 35%, and 55% in the control group, 10%, 60%, 25%, and 5% in the diarrhea group, 5%, 25%, 35%, and 35% in the constipation group, 5%, 20%, 40%, and 35% in the mixed group, there were statistically significant differences in intestinal flora intensity between the diarrhea group and the other three groups （P〈0.05）. Grade I , II ,III, IV intestinal flora diversity accounted for 5%, 20%, 65%, and 10% in the control group, 15%, 50%, 15%, and 20% in the diarrhea group, 10%, 30%, 45%, and 15% in the constipation group, 10%, 45%, 30%, and 15% in the mixed group, there were statistically significant differences between the diarrhea group, the mixed group and the control group, between the diarrhea group and the constipation group （P〈0.05）. The contents of enteric bacilli, enterococci, bifidobacteria, lactobacillus, bacteroides, and the B/E value in the control group were （8.18±0.68）, （6.74±0.89）, （8.93±0.87）, （7.05±1.07）, （8.42±0.64） logCFU/g watery stool, and （1.08±0.15）, those in the diarrhea group were （8.81±1.04）, （6.40±0.87）, （8.26±0.94）, （6.32±1.05）, （8.62±0.62） logCFU/g watery stool, and （0.95±0.14）, those in the constipation group were （8.24±0.87）, （6.58±1.05）, （8.54±1.04）, （6.48±0.84）, （9.24±0.64） logCFU/g watery stool, and （1.04±0.18）, and those in the mixed group were （8.83±1.12）, （6.78±1.19）, （8.62±0.91）, （6.21±1.04）, （8.48±0.69） logCFU/g watery stool, and （0.98±0.16）. Compared with the control group, the contents of enteric bacilli and bacteroides in IBS group increased, while the contents of bifidobacteria, lactobacillus, and the B/E value decreased （P〈0.05）, and there was no statistically significant difference in the content of enterococci （P〉0.05）. Conclusion There are different degrees of intestinal dysbacteriosis in patients with IBS, which is the most serious in diarrhea type IBS. Intestinal flora is one of the influencing factors of IBS.