感染性心内膜炎与肠道菌群的相关性研究

The relationship between infectious endocarditis and intestinal flora

目的探讨感染性心内膜炎与肠道乳杆菌、双歧杆菌和大肠埃希菌的临床相关性。方法选择2008年4月至2016年4月湖州市第一人民医院心内科病房收治的单纯感染性心内膜炎患者67例为观察组,选择同期来院体检结果正常者65例为对照组。分别收集观察组患者治疗前1天、治疗第3天和治疗1周后3个不同时间节点的粪便标本,同时收集对照组的粪便标本,通过FISH实验检测粪便中双歧杆菌和乳杆菌的含量差异,同时通过16SrRNA/DNA荧光定量PCR技术进一步明确观察组患者3个时期肠道双歧杆菌、大肠埃希菌和乳杆菌与对照组的数量差异。结果观察组患者治疗前1天双歧杆菌值为6.2%±0.56%,治疗第3天为4.3%±0.34%,治疗1周后为8.7%±0.56%,对照组双歧杆菌值为9.4%±0.98%。观察组患者治疗前1天乳杆菌值为5.4%±0.86%,治疗第3天为4.9%±0.24%,治疗1周后为6.1%±0.72%,对照组乳杆菌值为8.3%±0.51%。治疗前1天与治疗1周后,观察组患者双歧杆菌和乳杆菌值与对照组相比,差异均有统计学意义(P<0.05)。16SrRNA/DNA荧光定量PCR检测表明,观察组患者在3个治疗时期中肠道乳杆菌、双歧杆菌和大肠埃希菌数量的对数值与对照组比较差异均有统计学意义(P<0.05)。其中观察组患者双歧杆菌和乳杆菌数量在治疗第3天较低,1周后有所回升;大肠埃希菌数量在治疗第3天亦较低,但1周后没有明显回升。结论感染性心内膜炎患者肠道菌群数量与健康人相比有所下降,肠道乳杆菌、大肠埃希菌和双歧杆菌失调可能影响其发病和转归。

Objective To explore the relationship between the infectious endocarditis and intestinal Bifidobacteria,Escherichia coli and Lactobacilli.Methods The clinical data of 67 patients with infectious endocarditis admitted from April 2008 to April 2016 in the First People′s Hospital of Huzhou were analyzed retrospectively,with 65 healthy individuals as the controls.To detect the changes of content between Bifidobacteria,Escherichia coli and Lactobacilli,the specimens of excrements at 1 day before,3 days after,1 week after treatment and the healthy individuals were collected to extract the bacterial DNA for detection with FISH test.The numbers of Bifidobacteria,Escherichia coli and Lactobacilli were determined by using 16 SrRNA/DNA fluorescence quantitative PCR.Results The number of Bifidobacteriain the observation group was 6.2%±0.56% at 1 day before treatment,4.3% ±0.34% at 3 days after treatment and8.7%±0.56% at 1 week after treatment,while that in the control group was 9.4%±0.98%.The number of Lactobacilli in the observation group was 5.4% ±0.86% at 1 day before treatment,4.9% ±0.24% at3 days after treatment,and 6.1%±0.72% at 1 week after treatment,compared with the 8.3%±0.51%in the control group.At 1 day before treatment and 1 week after treatment,statistically significantly differences were observed in the numbers of the two bacteria between the two groups（P〈0.05）.There were statistically significant differences in the numbers of Bifidobacteria,Escherichia coli and Lactobacilli between the two groups at the 3 time points（P〈0.05）according to the results of 16S rRNA/DNA fluorescence quantitative PCR.The numbers of Bifidobacteria and Lactobacilli were lower at the third day of treatment,and increased again 1 week after treatment;The number of Escherichia coli was lower at the third day of treatment,but did not increase significantly 1 week after treatment.Conclusion The number of intestinal flora in patients with infectious endocarditis was lower than in healthy people.The disorder and decreasing of intestinal Bifidobacteria,Escherichia coli and Lactobacilli may affect the pathogenesis and outcomes of patients.