男性非肥胖非酒精性脂肪性肝病患者代谢指标与肠道菌群的相关性

Correlation Analysis of Metabolic Abnormality and Intestinal Flora in Male Non-obese Non-alcoholic Fatty Liver Disease Patients

【目的】探讨男性非肥胖非酒精性脂肪性肝病(NAFLD)患者代谢指标与肠道菌群的相关性。【方法】收集2019年1~6月在新疆医科大学第二附属医院消化内科就诊的男性患者,其中非肥胖NAFLD组(A组)20例、肥胖NAFLD组(B组)20例、健康对照组(C组)20例、代谢正常肥胖组(D组)20例。检测四组研究对象血红蛋白(Hb)、空腹血糖(FPG)、肌酐(SCr)、总胆固醇(TC)、三酰甘油(TG)及肠道菌群代谢产物短链脂肪酸(SCFA)和炎症因子白介素-17(IL-17)。采用16S rDNA高通量测序检测D组研究对象肠道菌群中的蓝藻菌门、拟杆菌门、厚壁菌门等,分析男性非肥胖非酒精性脂肪性肝病患者代谢指标、炎症因子与肠道菌群的相关性。【结果】四组Hb、TC水平比较差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示:TC是影响男性非肥胖NAFLD的独立危险因素。A组和B组血清SCFA水平均显著高于C组和D组,A组血清SCFA水平显著低于B组,其差异均有统计学意义(P<0.05);但四组血清IL-17水平比较差异无统计学意义(P>0.05)。四组肠道菌群结构均有其特异性,但拟杆菌门、厚壁菌门、变形菌门为主要优势菌群,A组拟杆菌门丰度显著高于B组,但B组厚壁菌门丰度显著低于A组,其差异均有统计学意义(P<0.05)。黑水仙菌门在C组中含量最高、在B组中含量最低。A组中蓝藻细菌门与SCr呈负相关(P<0.05);拟杆菌门丰度与IL-17呈负相关(P<0.05);厚壁菌门丰度与SCFA呈负相关(P<0.05)。B组中厚壁菌门、拟杆菌门与代谢指标及炎症因子均无统计学意义(P>0.05)。【结论】男性非肥胖NAFLD患者肠道菌群结构优于肥胖NAFLD患者,推测非肥胖和肥胖NAFLD人群肠道优势菌的不同可能是二者表型不同的原因之一,但优势菌与不同NAFLD表型间的因果关系尚待进一步研究。

【Objective】To investigate the correlation between metabolic indexes and intestinal flora in male patients with non obese non-alcoholic fatty liver disease(NAFLD).【Methods】Male patients in the Department of Gastroenterology of the Second Affiliated Hospital of Xinjiang Medical University from January to June 2019 were collected,including 20 cases of non obese NAFLD group(group A),20 cases of obese NAFLD group(group B),20 cases of healthy control group(Group C)and 20 cases of normal metabolism obese group(Group D).Hemoglobin(HB),fasting blood glucose(FPG),creatinine(SCR),total cholesterol(TC),triglyceride(TG),short chain fatty acid(SCFA)and inflammatory factor interleukin-17(IL-17)were detected.16S rDNA high-throughput sequencing was used to detect cyanobacteria,Bacteroides and Firmicutes in the intestinal flora of group D,and to analyze the correlation between metabolic indexes,inflammatory factors and intestinal flora in male non obese patients with nonalcoholic fatty liver disease.【Results】There were significant differences in Hb and TC levels among the four groups(P<0.05);Multivariate logistic regression analysis showed that TC was an independent risk factor for NAFLD in men.The levels of serum SCFA in the group A and the group B were significantly higher than those in the Group C and the Group D.The levels of serum SCFA in the group A were significantly lower than those in the group B(P<0.05);However,there was no significant difference in serum IL-17 levels among the four groups(P>0.05).Intestinal microflora structure of four groups had their own specificity,but Bacteroides,Firmicutes,proteus were the main dominant microflora.The abundance of Bacteroides in the group A was significantly higher than that in the group B,but the abundance of Firmicutes in the group B was significantly lower than that in the group A,the differences were statistically significant(P<0.05).The content of Narcissus was the highest in the group C and the lowest in the group B.There was a negative correlation between cyanobacteria and SCR in the non obese NAFLD group(P<0.05);The abundance of Bacteroides was negatively correlated with IL-17(P<0.05);The abundance of Firmicutes was negatively correlated with SCFA(P<0.05).There was no significant difference in Firmicutes,Bacteroides,metabolic indexes and inflammatory factors in the obese NAFLD group(P>0.05).【Conclusion】The structure of intestinal microflora in male non obese NAFLD patients is better than that in obese NAFLD patients.It is speculated that the difference of intestinal dominant bacteria between non obese and obese NAFLD patients may be one of the reasons for their different phenotypes,but the causal relationship between dominant bacteria and different NAFLD phenotypes needs to be further studied.