复方大黄灌肠液对尿毒症患者的作用

The effect of compound rhubarb enema in patients with uremia

目的探讨复方大黄灌肠液对尿毒症患者肠道菌群、血清内毒素及炎症因子的影响。方法选取2019年6月至2020年4月我院收治的90例尿毒症患者为研究对象,入选患者随机分为常规组与观察组,各45例。所有患者均采用常规治疗(血液透析,降压、降糖、调节饮食,改善贫血),观察组患者在此基础上给予复方大黄灌肠液进行灌肠。对比治疗前后2组患者肠道菌群、血清内毒素及炎症因子水平变化,同时对比两组患者营养不良和多脏器功能障碍综合征(MODS)发生率。结果治疗前,两组患者肠道菌群OTUs数量、门水平和属水平相对丰度差异均无统计学意义(均P>0.05)。治疗后常规组患者肠道菌群OTUs数量、门水平和属水平相对丰度无明显改变(均P>0.05);而观察组患者肠道菌群OTUs数量、肠道厚壁菌门、放线菌门、双歧杆菌属、芽胞杆菌属、乳杆菌属、假单胞杆菌属相对丰度均升高,且观察组高于常规组(均P<0.05)。观察组患者治疗后肠道变形菌门、梭杆菌门、衣原体门、志贺菌属、埃希菌属、沙门菌属、梭杆菌属、衣原体属相对丰度均下降,且观察组低于常规组(均P<0.05)。LEfSe分析发现治疗后观察组患者肠道biomarker主要为互养菌目、理研菌科、普雷沃菌科、毛螺旋菌科,而对照组患者肠道biomarker主要为嗜胆菌属、耶尔森菌属、葡萄球菌属。治疗前两组患者血清内毒素、炎症因子水平对比差异无统计学意义(均P>0.05),治疗后两组患者血清内毒素、炎症因子水平均下降,且治疗后观察组血清内毒素、炎症因子水平均低于常规组(均P<0.05)。观察组患者营养不良(15.56%vs 35.56%)、MODS(4.44%vs 22.22%)发生率均低于常规组(均P<0.05)。结论复方大黄灌肠液可改善尿毒症患者肠道菌群,降低血清内毒素及炎症因子水平,减少患者营养不良和MODS发生率,值得临床推广。

Objective To explore the effect of compound rhubarb enema on intestinal flora, endotoxin and inflammatory factors in uremic patients. Methods A total of 90 uremic patients treated in our hospital from Jun 2019 to Apr 2020 were divided into observation group or routine group randomly, 45 cases in each group. All the patients were treated with conventional method;the observation group was additionally given compound rhubarb enema. The changes of intestinal flora, serum endotoxin and inflammatory factors in the two groups before and after treatment, incidences of malnutrition and multiple organ dysfunction syndrome(MODS) were compared between groups. Results Before treatment, there were no significant differences in intestinal flora OTUs, relative abundances at phylum/genus level between the two groups(all P>0.05). There were no significant differences in the number of intestinal flora OTUs and relative abundances at phylum/genus level in the routine group before and after treatment(P>0.05). The OTU number of intestinal flora and relative abundances of Firmicutes, Actinobacteria, Bifidobacterium, Bacillus, Lactobacillus and Pseudomonas in the observation group increased after treatment, and were higher than those in the routine group after treatment(all P<0.05). After treatment, the relative abundances of Proteobacteria, Fusobacteria, Chlamydiae, Shigella, Escherichia, Salmonella, Ruminococcus and Chlamydia in the observation group decreased, and were lower than those in the routine group, and the differences were statistically significant(all P<0.05). LEfSe analysis showed that the biomarker in the observation group was mainly probiotics, such as Synergistales, Rikenellaceae, Prevotellaceae and so on, while before and after treatment, the biomarker in the routine group was mainly harmful bacterium, such as Bilophila, Yersinia and Staphylococcus, etc. There were no significant differences in serum endotoxin and inflammatory factors between the two groups before treatment(all P>0.05). After treatment, the levels of serum endotoxin and inflammatory factors in the two groups decreased, and those of serum endotoxin and inflammatory factors in the observation group were lower than in the routine group;the differences were statistically significant(all P<0.05). The incidences of malnutrition and MODS in the observation group were lower than those in the routine group(all P<0.05). Conclusion In uremic patients, compound rhubarb enema can significantly improve the intestinal microecological structure and reduce the levels of endotoxin and inflammatory factors, and reduce the incidences of malnutrition and MODS.