老年髋关节置换术后谵妄患者肠道菌群结构变化研究

Changes of intestinal flora in elderly patients with postoperative delirium after hip arthroplasty

目的探究髋关节置换术后发生谵妄(POD)的老年患者肠道菌群的结构改变。方法研究类型为病例对照研究。选取广州中医药大学第三附属医院2019年9月至2021年8月腰硬联合麻醉下行髋关节置换术的患者,随机选取其中有POD发生的患者13例(POD组),其中男7例,女6例,年龄(72.62±3.25)岁;同时随机选取无POD发生的患者20例(Non-POD组),其中男13例,女7例,年龄(73.00±4.19)岁。16S rRNA测序技术被用于分析两组患者术前12 h及术后48~60 h的粪便菌群的结构变化。计数资料采用χ^(2)检验,计量资料采用t检验。结果POD组术后的Chao1指数[(333.32±97.86)比(455.20±153.50)]及Shanon指数[(3.27±0.79)比(5.05±1.06)]均显著低于Non-POD组(均P<0.05);POD组术后厚壁菌门[(52.45±7.38)%比(46.70±6.94)%]、变形菌门[(21.45±4.73)%比(16.42±3.55)%]相对丰度均高于Non-POD组,放线菌门[(32.35±8.60)%比(42.75±9.43)]、拟杆菌门[(12.68±3.78)%比(21.37±4.17)%]的相对丰度均低于Non-POD组,差异均有统计学意义(均P<0.05);POD组术后萨特氏菌属[(16.45±3.74)%比(10.18±2.40)]、葡萄球菌属[(21.38±4.60)%比(14.92±2.94)%]、变形杆菌属[(15.33±3.22)%比(9.48±1.67)%]、梭状芽孢杆菌属[(28.55±4.90)%比(14.70±2.92)%]相对丰度均高于Non-POD组,双歧杆菌属[(29.41±5.80)%比(45.24±7.08)%]、柔嫩梭菌属[(10.18±2.04)%比(13.50±2.31)%]、拟杆菌属[(27.65±3.59)%比(34.76±4.72)%]相对丰度均低于Non-POD组,差异均有统计学意义(均P<0.05)。结论肠道菌群多样性下降;肠道菌群门、属水平上结构变化可能参与了髋关节置换术后POD的发生。

Objective To investigate the changes of intestinal flora in elderly patients with postoperative delirium(POD)after hip arthroplasty.Methods This was a case control study.The patients who took hip arthroplasty under combined spinal and epidural anesthesia in The Third Affiliated Hospital of Guangzhou University of ChineseMedicine from September 2019 to August 2021 were recruited;among whom,13 patients with POD(POD group),including 7 males and 6 females who were(72.62±3.25)years old,and 20 patients without POD(non-POD group),including 13 males and 7 females who were(73.00±4.19)years old,were randomly selected.The 16S rRNA sequencing technology was used to analyze the changes of intestinal flora 12 hours before and 48 to 60 hours after the operation.The count data were compared by χ^(2) test,and the measurement data by t test.Results The postoperative Chao1 index and Shanon index of the POD group were significantly lower than those of the non-POD group[(333.32±97.86)vs.(455.20±153.50)and(3.27±0.79)vs.(5.05±1.06);both P<0.05].The relative abundances of postoperative proteobacteria and firmicutes were higher and the relative abundances of postoperative bacteroides,actinomycota,and bacteroidetes were lower in the POD group than in the non-POD group after the surgery[(21.45±4.73)%vs.(16.42±3.55)%,(52.45±7.38)%vs.(46.70±6.94)%,(12.68±3.78)%vs.(21.37±4.17)%,(32.35±8.60)%vs.(42.75±9.43)%,and(12.68±3.78)%vs.(21.37±4.17)%],with statistical differences(all P<0.05).The relative abundances of postoperative sartorella,staphylococcus,proteus,and clostridia were higher and the relative abundances of bifidobacterium,clostridium tenuis,and bacteroides were lower in the POD group than in the non-POD group after the surgery[(16.45±3.74)%vs.(10.18±2.40)%,(21.38±4.60)%vs.(14.92±2.94)%,(15.33±3.22)%vs.(9.48±1.67)%,(28.55±4.90)%vs.(14.70±2.92)%,(29.41±5.80)%vs.(45.24±7.08)%,(10.18±2.04)%vs.(13.50±2.31)%,and(27.65±3.59)%vs.(34.76±4.72)%],with statistical differences(all P<0.05).Conclusions The diversity of intestinal flora is decreasing;structural changes on the phylum and genus levels of intestinal flora may be involved in the occurrence of POD after hip arthroplasty.