脓毒性休克患者肠道微生态变化临床研究

Clinical investigation of intestinal microbiota in septic shock patients

目的对比脓毒性休克患者与健康志愿者的肠道菌群,以明确ICU脓毒性休克患者肠道菌群组成特点。方法采用前瞻性研究方法,选择2015年6月至2016年2月郑州大学第一附属医院重症医学科收治的脓毒性休克患者及同期健康志愿并肠道粪便样本各15例,提取菌群DNA进行16S rDNA基因测序,评估肠道菌群组成对临床预后影响.采用香农-威纳指数评估菌群多样性.结果对比健康志愿者,脓毒性休克患者肠道菌群组成变化较大,变形菌门比例变化较为显著,健康志愿者平均相对比例为3.53%,脓毒性休克患者为23.71%,差异有统计学意义(P=0.000 6 );梭杆菌比例也相对增高,健康志愿者平均相对比例为0.12%,脓毒性休克患者为1.27%,但差异无统计学意义(P=0.059)脓毒性休克患者肠道菌群种类较多,本研究鉴別出29种.每个患者肠道菌群组成具有高度个体化分析肠道菌群组成与临床结局之间关系发现,健康志愿者与脓毒性休克患者香农-威纳指数差异无统计学意义(P=0.12),且服用益生菌、使用肠内营养均不能降低院内病死率(P=0.59, P=0.58 )结论脓毒性休克患者肠道菌群组成特点为种群多样性、个体化程度均较高,但也有单个菌属过度繁殖的现象肠道菌群组成马临床结局之间关系需要大样本研究进一步探索.

Objective To compare the intestinal microbiota of septic shock patients and healthy subjects, and study the composition of the intestinal microbiota and its effect on septic shock patients in the intensive care unit (ICU). Methods A total of 15 stool samples were prospectively collected from septic shock patients admitted to the ICU in the First Affiliated Hospital of Zhengzhou University between June 2015 and February 2016, while 15 samples from healthy subjects served as controls. Bacterial DNA was submitted for 16S rDNA gene sequencing. The association between gut microbiota composition and clinical parameters was evaluated. Shannon index was used to assess the bacterial diversity. Results Compared with the healthy subjects, the composition of intestinal microbiota in septic shock patients changed significantly. The abundance of Proteobacteria and Fusobacteria were significantly higher in septic shock patients than in healthy subjects (23.71% vs 3.53%, P=0.0006;1.27% vs 0.12%, P=0.059, respectively). In this study, 29 species were identified, and the composition of intestinal microbiota in each patient was highly individualized. There was no significant difference in Shannon index between septic shock patients and healthy subjects (P=0.12). Conclusions The composition of intestinal microbiota in septic shock patients was characterized by high diversity and individualization, but there was the phenomenon of overproduction of single bacteria genus. The relationship between the composition of intestinal microbiota and clinical outcomes requires further exploration by large sample studies.