老年抑郁症患者与肠道菌群失调的关系

The relationship between depression and intestinal microflora imbalance in the elderly

目的:探究老年人抑郁症与发生老年人肠道微生物菌群失调的发病情况及其治疗方法。方法:选择2017年7月至2018年7月西南医科大学附属医院精神科接诊并未治愈的255例年龄在60岁以上的抑郁症患者作为研究对象,并以此期间体检的健康人群作为实验对照组。采集新鲜粪便并记录两组人群的心理状态的变化,并定量检测肠道菌群数量,分析两组人群双歧杆菌和肠杆菌菌数的对数比(B/E值)。结果:老年抑郁兼肠道菌群失调患者的抑郁中重度比例(13.72%和13.33%)高于老年抑郁症患者抑郁中重度比例(3.92%和2.74%),差异有统计学意义(P<0.01);实验组老年抑郁症患者新鲜粪便中的双歧杆菌、肠杆菌数量以及B/E值分别为(7.34±0.67)log10CFU/g湿便、(11.38±1.92)log10CFU/g湿便、0.64±0.52;而对照组结果分别为(11.33±0.23)log10CFU/g湿便、(7.93±1.69)log10CFU/g湿便、1.42±0.25,实验组低于对照组(P<0.01)。实验组肠球菌的菌群数量高于对照组(P<0.01)。后期经过相应的肠道菌群失调的治疗措施,实验组老年抑郁兼肠道菌群失调患者治疗前后SDS评分(84.36±7.93)分比(59.30±2.94)分,差异有统计学意义(P<0.001);SAS评分(83.81±4.92)分比(58.53±10.39)分,差异有统计学意义(P<0.001)。结论:老年抑郁症患者存在明显的肠道菌群失调,有益菌减少,需氧菌增多,肠道定植抵抗力减弱。

Objective To investigate the incidence of intestinal microflora imbalance and its treatment in elderly patients with depression.Methods A total of 255 patients with depression aged over 60 years who were admitted to the psychiatry department of our hospital but had not achieved symptom remission from July 2017 to July 2018 were included as the experimental group.During the same period,healthy people taking health examination at our hospital were enrolled as the control group.Fresh fecal samples were collected and changes in mental state was recorded.The intestinal flora was quantitatively identified.The logarithmic ratio of bifidobacterium to enterobacter(B/E ratio)was analyzed and used as a criterion for determining intestinal flora imbalance.Methods The proportion of patients with moderate to severe depression and concurrent intestinal flora imbalance was higher than that of patients with moderate to severe depression alone(13.72%vs.3.92%,13.33%vs.2.74%,P<0.01).The numbers of Bifidobacteria and Enterobacter and the B/E ratio in fresh stool specimens were lower in the experimental group than in the control group[(7.34±0.67)log10CFU/gwet stoolvs.(11.33±0.23)log10CFU/g wet stool,(11.38±1.92)log10CFU/gwet vs.(7.93±1.69)log10CFU/g wet stool,(0.64±0.52)vs.(1.42±0.25),P<0.01].The numbers of Enterococci were higher in the experimental group than in the control group(P<0.01).There were significant differences in Self-Rating Depression Scale(SDS)and Self-Rating Anxiety Scale(SAS)scores in elderly patients with depression and concurrent intestinal microflora imbalance before and after specific treatment(84.36±7.93 vs.59.30±2.94,83.81±4.92 vs.58.53±10.39,P<0.001)and depression symptoms were significantly improved in patients with intestinal microflora imbalance.Conclusions Elderly patients with depression are clearly prone to intestinal flora imbalance,which is characterized by decreased beneficial bacteria,increased aerobic bacteria and weak intestinal colonization resistance.