糖尿病肾脏病早期内热证与非内热证患者肠道菌群及脂多糖的相关性分析

Correlation analysis of intestinal flora and lipopolysaccharide in early diabetic kidney diseases patients with internal heat and non internal heat syndrome

目的:探讨糖尿病肾脏病(DKD)早期内热证与非内热证患者肠道菌群及脂多糖(LPS)的相关性。方法:收集27例DKD早期患者(内热证18例,非内热证9例)的血清及粪便标本,采用ELISA法及16S rRNA技术分别对血清LPS及菌群进行分析。结果:与非内热证患者比较,内热证患者尿白蛋白/肌酐比值显著升高(P<0.05),两组患者菌群的β多样性差异有统计学意义(P<0.01);与非内热证患者比较,内热证患者促炎菌群Bacteroidaceae、Bacteroides及Lachnoclostridium相对丰度显著升高(P<0.01,P<0.05),而抑炎菌群Prevotellaceae、Ruminococcaceae_UCG-003、Pseudobutyrivibrio及Lactobacillus相对丰度显著下降(P<0.01,P<0.05)。结论:LPS可能是DKD早期患者“内热”的物质基础;DKD早期患者肠道内存在促炎及抑炎菌平衡紊乱,可能是“内热”及LPS产生的病机过程。

Objective: To explore the correlation of intestinal flora and lipopolysaccharide(LPS) in early diabetic kidney diseases(DKD) patients with internal heat and non internal heat syndrome. Methods: Serum and fecal samples were collected from 27 early DKD patients(18 patients with internal heat syndrome, and 9 patients with non internal heat syndrome). Serum LPS and bacterial flora were analyzed by ELISA and 16S rRNA technology respectively. Results: Compared with the patients with non internal heat syndrome, the urinary albumin/creatinine ratio were significantly increased of patients with internal heat(P<0.05);there were significant differences in the β-diversity of intestinal flora between two groups(P<0.01). Compared with the non internal heat syndrome group, the relative abundance of Bacteroidaceae, Bacteroides, Lachnoclostridium of patients with internal heat syndrome had significantly increased(P<0.01, P<0.05), while the relative abundance of Prevotellaceae, Ruminococcaceae_UCG-003, Pseudobutyrivibrio and Lactobacillus of patients with internal heat syndrome had significantly decreased(P<0.01, P<0.05).Conclusion: LPS may be the material basis of ‘internal heat’ in early DKD patients. There was imbalance of pro-inflammatory and anti-inflammatory flora in the early DKD patients, which may be the pathogenesis of ‘internal heat’ and LPS production.