肠道菌群分析及粪便炎性标志物检测在炎症性肠病活动度评估中的作用

Roles of analysis of intestinal microflora and detection of fecal inflammatory markers in evaluation of the activity of inflammatory bowel disease

目的探讨肠道菌群和粪便炎性标志物在炎症性肠病(IBD)活动度评估中的临床价值。方法共纳入120例IBD患者为研究组,其中溃疡性结肠炎(UC)患者68例,克罗恩病(CD)患者52例。选择30例经结肠镜检查正常的健康体检者为对照组。采集全部研究对象的新鲜粪便标本进行粪便细菌培养及炎性标志物检测,比较不同疾病活动度IBD患者的肠道菌群及粪便钙卫蛋白(FC)、乳铁蛋白(LF)、基质金属蛋白酶-9(MMP-9)、髓过氧化酶(MPO)水平的变化。结果与对照组比,UC和CD患者肠道中肠杆菌、肠球菌、拟杆菌、消化球菌及酵母菌数量均明显增加(P<0.05),双歧杆菌、乳杆菌及真杆菌数量明显减少(P<0.05)。UC患者梭菌数量较对照组增加(P<0.05),CD患者梭菌数量较对照组减少(P<0.05)。UC、CD活动期患者肠杆菌、肠球菌、拟杆菌、消化球菌及酵母菌数量明显多于缓解期患者(P<0.05),双歧杆菌、乳杆菌及真杆菌数量明显少于缓解期患者(P<0.05),且重度活动期患者肠道菌群改变较轻、中度活动期改变更明显(P<0.05)。UC活动期患者梭菌数量明显多于缓解期(P<0.05),CD活动期患者梭菌数量明显少于缓解期(P<0.05)。UC和CD患者粪便中FC、LF、MMP-9及MPO水平均显著高于对照组(P<0.05)。UC、CD活动期患者FC、LF、MMP-9及MPO水平显著高于缓解期患者(P<0.05),且重度活动期患者高于轻、中度活动期患者(P<0.05)。结论肠道菌群变化和粪便中FC、LF、MMP-9及MPO水平可作为IBD患者疾病活动性评估的辅助指标。

Objective To discuss the clinical values of intestinal microflora and fecal inflammatory markers in evaluating the activity of inflammatory bowel disease （IBD） . Methods 120 patients with IBD were includ ed, including 68 patients with ulcerative colitis （UC） and 52 patients with Crohn＇s disease （CD）, with 30 healthy individuals as the control group. Fresh fecal samples were collected from all the subjects for cultu- ring of bacteria and detection of inflammatory markers. The changes of intestinal flora and the levels of fecal calprotectin （FC） , lactoferrin （LF） , matrix metalloproteinase 9 （MMP-9） and myeloperoxidase （MPO） in IBD patients with different disease activity were compared. Results Compared with the control group, the numbers of Enterobacters, Enterococci, 13acteroides, Peptococci and Yeasts in patients with UC and CD in- creased significantly （Ps^O. 05）, while those of 13ifidobacteria, Lactobacilli and Eubacteria reduced sig nificantly （P〈0.05） . The number of Clostridia in UC group was higher than that in the control group （P〈0.05）, while that ofClostridia in CD group was lower than that in the control group （P〈0.05） . The numbers of Enterobacters, Enterococci, Bacteroides, Peptococci and Yeasts in the active stage groups of UC and CD were obviously higher than those in the remission stage groups （Ps〈O. 05） . The numbers of Bifidobacteria, Lactobacilli and Eubacteria in the active stages of UC and CD were obviously lower than those in the remission stage groups （Ps〈O. 05） . The change of intestinal flora in the active stages of severe diseases was more obvious than in the active stages of mild and moderate diseases （P〈0.05） . The number of Clostridia in UC active stage was significantly higher than that in remission stage （P〈0.05）, while that in CD active phase was significantly lower than in remission stage （P〈0.05） . The levels of FC, LF, MMP-9 and MPO in the feces of patients with UC and CD were significantly higher than in the control group （P〈0.05） . The levels of FC, LF, MMP-9 and MPO in the active stages of UC and CD were significantly higher than those in the remission stage groups （P〈0.05）, and those in the active stages of severe diseases were higher than in the active stages of mild and moderate diseases （P〈0.05） . Conclusion The change of intestinal flora and the levels of FC, LF, MMP-9 and MPO in feces can be used as the secondary indicators for evaluation of disease activity in IBD patients.