胃肠道穿孔感染性休克患者肠道菌群及其与血清C反应蛋白和降钙素原的相关性

Intestinal flora in patients with gastrointestinal perforated septic shock and its correlation with serum CRP and PCT

目的探究胃肠道穿孔感染性休克患者肠道菌群及其与血清C反应蛋白(CRP)、降钙素原(PCT)的相关性。方法选取2017年1月到2019年6月辽宁省人民医院收治的110例胃肠道穿孔致感染性休克患者,按照APACHEII评分分为A组(APACHEII评分<20分,n=67)和B组(APACHEII评分≥20分,n=43)。另选52例同期体检正常的健康者作为正常组。检测各组对象血中免疫细胞数、肠道微生物及血清CRP、PCT水平,并分析患者肠道菌群与血清CRP、PCT水平的相关性。结果各组对象血液中白细胞、中性粒细胞、CD4^+细胞、CD4^+/CD8^+水平均为B组>A组>正常组,差异均有统计学意义(均P<0.05)。各组对象肠道肠杆菌数量为B组>A组>正常组,双歧杆菌数量及B/E值均为B组<A组<正常组,差异均具有统计学意义(均P<0.05)。各组对象血清CRP、PCT水平均为B组>A组>正常组,差异均具有统计学意义(均P<0.05)。Pearson相关性分析显示,双歧杆菌数量、B/E值与血清CRP、PCT分别呈负相关(r=-0.624,-0.746;-0.638,-0.757,均P<0.05)。结论胃肠道穿孔感染性休克患者存在以双歧杆菌减少和肠杆菌增加为主要特点的肠道菌群失衡,且双歧杆菌数量和B/E值与血清CRP、PCT水平具有一定相关性,推测肠道菌群可能参与了疾病的发生和发展过程。

Objective To investigate the intestinal flora in patients with gastrointestinal perforation septic shock(GPSS) and its correlation with serum C-reactive protein(CRP) and procalcitonin(PCT). Methods A total of 110 patients with GPSS in the People′s Hospital of Liaoning Province from January 2017 to June 2019 were enrolled and divided into group A(APACHE II score <20, n=67) or group B(APACHE II score ≥20, n=43), with 52 healthy examinees as the control group. The count of immune cells, count of intestinal microbes and levels of serum CRP and PCT were measured, and the correlation between intestinal flora and levels of serum CRP and PCT was analyzed. Results The levels of white blood cells, neutrophils, CD4^+ and CD4^+/CD8^+ in the blood were the highest in group B, followed by group A and then control group(all P<0.05), so was the number of Enterobacteriaceae in the intestinal tract, while that of Bifidobacteria and B/E value were the lowest in group B, followed by group A and then control group(all P<0.05). Similarly, the levels of serum CRP and PCT were the highest in group B, followed by group A and then control group(all P<0.05). Pearson correlation analysis showed that the number of Bifidobacteria and B/E value were negatively correlated with serum CRP and PCT(r=-0.624,-0.746,-0.638,-0.757;all P<0.05). Conclusion There is an imbalance of intestinal flora in patients with gastrointestinal perforation septic shock, which is characterized by decreased Bifidobacteria and increased Enterobacteria. Bifidobacteria and B/E have a certain correlation with serum CRP and PCT, indicating that the intestinal flora may be involved in the pathogenesis and development of the disease.