结直肠腺瘤的肠道微生态分析及临床意义

Analysis and clinical significance of gut microbiota in colorectal adenoma

目的分析结直肠腺瘤(CRA)患者肠道菌群特点,构建模型用于结直肠早期病变的筛查。方法收集2017年1月至2018年7月在苏州大学附属第一医院行肠镜检查的96例CRA患者为CRA组,同期收集59名肠镜正常的健康体检者作为对照组。所有受试者均接受粪便隐血试验(FOBT)和血清癌胚抗原(CEA)检测。通过16S rRNA测序比较两组肠道菌群组成,基于两者差异菌株构建加权失衡指数(WDI)模型,分析模型与FOBT和CEA在CRA诊断中的效能。结果与对照组比较,CRA组肺炎克雷伯菌、粪副拟杆菌、梭杆菌属丰度增加;放线菌门、毛螺菌科、布劳特氏菌属、双歧杆菌属、罗氏杆菌属、链球菌属、假丁酸弧菌属、溃疡梭杆菌丰度减少。FOBT诊断CRA的灵敏度为15.63%,特异度为91.53%,误诊率为8.47%,漏诊率为84.38%;CEA诊断CRA的灵敏度为71.88%,特异度为52.54%,曲线下面积(AUC)为0.614;WDI诊断CRA的灵敏度为83.33%,特异度为71.19%,AUC为0.795。结论CRA肠道菌群构成具有特征性变化。WDI模型的灵敏度优于FOBT及血清CEA,或许有望成为结直肠肿瘤早期筛查的潜在标志物。

Objective To analyze the characteristics of gut microbiota in colorectal adenoma(CRA)and to build a model to screen early colorectal lesions.Methods A total of 96 patients with CRA who underwent colonoscopy in the First Affiliated Hospital of Soochow University from January 2017 to July 2018 were enrolled as CRA group,and 59 healthy subjects with normal colonoscopy during the same period were enrolled as control group.All subjects underwent faecal occult blood test(FOBT)and serum carcinoembryonic antigen(CEA)detection.The gut microbiota composition of two groups was compared by 16S rRNA sequencing,and the weighted dysbiosis index(WDI)model was constructed based on the different strains of two groups,and the efficacy of the model,FOBT,and CEA in the diagnosis of CRA was analyzed.Results Compared with control group,the abundance of Klebsiella Pneumoniae,Parabacteroides Merdae,and Fusobacterium were increased in CRA group;while the abundance of Actinobacteria,Lachnospiraceae,Blautia,Bifidobacterium,Roseburia,Streptococcus,Pseudobutyrivibrio,and Fusobacterium Ulcerans were decreased.The sensitivity of FOBT in the diagnosis of CRA was 15.63%,specificity was 91.53%,the false positive rate was 8.47%,the false negalive rate was 84.38%;the sensitivity of CEA in the diagnosis of CRA was 71.88%,specificity was 52.54%,the area under the curve(AUC)was 0.614;the sensitivity of WDI in the diagnosis of CRA was 83.33%,specificity was 71.19%,AUC was 0.795.Conclusion The composition of gut microbiota of CRA showes characteristic changes.The sensitivity of WDI model is better than that of FOBT and serum CEA,which may be a potential marker for early screening of colorectal tumors.