维持性血液透析患者肠道菌群与骨矿物质代谢异常相关性研究

Study on the Relationship Between Intestinal Flora and Abnormal Bone Mineral Metabolism in Maintenance Hemodialysis Patients

目的:研究维持性血液透析患者肠道菌群改变与骨矿物质代谢异常的关系。方法:选取30例维持性血液透析(maintenance hemodialysis,MHD)患者,随机分为HD组、HD+HDF组和HD+HDF+HP组。另选取10名健康人作为对照组。测定血清全段PTH(iPTH)、钙、磷。采用16S rRNA测序方法测定肠道菌群的含量。结果:三组血透患者在年龄、KT/V、URR、Alb、Hb方面差异均无统计学意义(P>0.05)。尿毒症患者血清PTH、磷高于健康对照组(P<0.05),Hb、Alb显著低于健康对照组(P<0.05)。HD+HDF+HP组血清PTH、磷低于HD组和HD+HDF组(P<0.05,P<0.05)。与健康对照组相比,MHD患者双歧杆菌和嗜酸乳杆菌水平显著降低(P<0.01,P<0.01),大肠杆菌和粪肠球菌水平显著升高(P<0.05,P<0.05)。HD+HDF+HP组嗜酸乳杆菌含量显著高于HD组和HD+HDF组(P<0.01,P<0.01),大肠杆菌含量显著低于HD组和HD+HDF组(P<0.01,P<0.05)。CKD5d期患者嗜酸乳杆菌含量与PTH、血磷水平呈负相关(r=-0.181,P=0.010;r=-0.247,P=0.000);双歧杆菌含量与PTH、血磷水平呈负相关(r=-0.176,P=0.013;r=-0.136,P=0.041),大肠杆菌与PTH、血磷水平呈正相关(r=0.278,P=0.032;r=0.167,P=0.003);粪肠球菌与PTH、血磷水平呈正相关(r=0.543,P=0.013;r=0.446,P=0.025)。结论:尿毒症会导致肠道菌群改变,充分血液净化治疗能改善肠道菌群,CKD5d期患者肠道菌群改变与骨矿物质代谢异常存在显著相关性。

Objective:To study the relationship between intestinal flora changes and bone mineral metabolism in maintenance hemodialysis patients.Methods:Thirty maintenance hemodialysis patients were randomly divided into HD group,HD+HDF group and HD+HDF+HP group.Another 10 healthy persons were selected as control group.Parathormone,calcium and phosphorus were measured.The content of intestinal flora was determined by 16S rRNA sequencing.Results:There were no significant differences in age,KT/V,URR,ALB and Hb among the three groups(P>0.05).The levels of serum parathormone and phosphorus in uremic patients were significantly higher than those in healthy control group(P<0.05),and Hb and Alb were significantly lower than those in healthy control group(P<0.05).The serum levels of parathormone and phosphorus in HD+HDF+HP group were significantly lower than those in HD group and HD+HDF group(P<0.05;P<0.05).Compared with healthy control group,the levels of Bifidobacterium and Lactobacillus acidophilus in CKD5d patients were significantly lower(P<0.01;P<0.01),while the levels of Escherichia coli and Enterococcus faecalis were significantly higher(P<0.05;P<0.05).The content of Lactobacillus acidophilus in HD+HDF+HP group was significantly higher than that in HD group and HD+HDF group(P<0.01;P<0.01),and the content of Escherichia coli in HD+HDF group was significantly lower than that in HD group and HD+HDF group(P<0.01;P<0.05).Lactobacillus acidophilus was negatively correlated with the levels of serum parathormone and phosphorus(r=-0.181,P=0.010;r=-0.247,P=0.000);Bifidobacterium was negatively correlated with the levels of parathormone and serum phosphorus(r=-0.176,P=0.013;r=-0.136,P=0.041);E.coli was positively correlated with the levels of parathormone and serum phosphorus(r=0.278,P=0.032;r=0.167,P=0.003);The cocci were positively correlated with the levels of parathormone and serum phosphorus(r=0.543,P=0.013;r=0.446,P=0.025).Conclusion:Uremia can affect intestinal flora,and adequate blood purification treatment can improve intestinal flora disorder.Bone mineral metabolism was correlated with intestinal flora changes in patients with CKD5d.