改善肠道菌群失调对强直性脊柱炎疗效的影响

Effect of Improving Intestinal Flora Imbalance on the Efficacy of Ankylosing Spondylitis

目的探讨通过改善肠道菌群失调,观察治疗后低氧诱导因子-1α(HIF-1α)、C反应蛋白(CRP)及分泌型免疫球蛋白A(SIgA)等指标表达下降以及Bath强直性脊柱炎活动性指数(BASDAI)降低的情况,分析改善肠道菌群失调在强直性脊柱炎(AS)综合治疗中的积极意义。方法选取2018年8月至2020年10月于河南省人民医院就诊的90例AS住院患者,以及门诊筛选的30例健康志愿者,分为A、B、C、D组,其中30例AS患者为A组(从未用过药),30例AS患者为B组(该组患者使用三联活菌联合非甾体抗炎药或肿瘤坏死因子抑制剂3个月),30例AS患者为C组(该组既往单纯使用非甾体抗炎药或肿瘤坏死因子抑制剂3个月或以上),D组为30例健康志愿者,将4组患者的粪便、血液等标本数据进行收集,回顾性分析治疗后粪便中大肠埃希菌数、乳杆菌以及双歧杆菌数量和血清HIF-1α、CRP及SIgA等指标表达改变情况。结果与D组相比,A组患者粪便中大肠埃希菌数、乳杆菌以及双歧杆菌均减少,差异有统计学意义(P<0.05),外周血HIF-1α、CRP及SIgA水平均升高,差异有统计学意义(P<0.05);B组3种肠道菌群数量相对于A组均升高,差异有统计学意义(P<0.05),但双歧杆菌数量与D组差异无统计学意义(P>0.05),外周血HIF-1α、CRP、SIgA水平较A组均降低,差异有统计学意义(P<0.05);C组双歧杆菌数量较A组升高,但仍低于B组和D组,差异有统计学意义(P<0.05),同时C组的HIF-1α、CRP、SIgA水平较A组均降低,但仍高于B组和D组,差异有统计学意义(P<0.05)。在BASDAI方面,B组较A组和C组均降低,差异有统计学意义(P<0.05),而C组较A组尽管降低,但差异无统计学意义(P>0.05)。结论肠道菌群失调在AS患者中普遍存在,且与外周血反映AS疾病活动的HIF-1α、CRP及SIgA等指标的高表达相一致;相比于传统的单纯免疫抑制剂治疗,通过改善肠道菌群失调,综合治疗后HIF-1α与CRP及SIgA表达下降,同时反映AS疾病活动程度的BASDAI也降低,提示改善肠道菌群失调对提高AS的综合疗效具有积极的意义。

Objective To explore by improving intestinal flora imbalance and observe the decrease in the expression of hypoxia-inducible factor-1α(HIF-1α),C-reactive protein(CRP)and secretory IgA(SIgA)and other indicators after treatment,as well as the decrease of Bath ankylosing spondylitis disease activity index(BASDAI)analyze the positive significance of improving intestinal flora imbalance in comprehensive treatment of ankylosing spondylitis(AS).Methods Ninety inpatients with AS who were treated in Henan Provincial People’s Hospital and 30 healthy volunteers screened in the outpatient from August 2018 to October 2020 were selected,and they were divided into groups A,B,C and D.Thirty AS patient were in group A(never use medicine),30 AS patients were in group B(the patients in this group were treated with triple viable bacteria combining with non-steroidal anti-inflammatory drugs or tumor necrosis factor inhibitors for 3 months),30 AS patients were in group C(the group always simple use of non-steroidal anti-inflammatory drugs or tumor necrosis factor inhibitor 3 months or more),and group D consisted of 30 healthy volunteers.The feces and blood specimen data of the four groups of patients were collected,and the number of Escherichia coli,Lactobacillus and Bifidobacteria in feces and the expression of HIF-1α,CRP and SIgA in serum after treatment were retrospectively analyzed.Results Compared with group D,the number of Escherichia coli,Lactobacillus and Bifidobacteria in the feces of group A were decreased,and the differences were statistically significant(P<0.05).The levels of HIF-1α,CRP and SIgA in serum were all increased,and the differences were statistically significant(P<0.05).Compared with group A,the number of three intestinal flora in group B was increased,and the differences were statistically significant(P<0.05),while the number of Bifidobacteria was not different from the control group D(P>0.05).At the same time,the levels of HIF-1α,CRP and SIgA in serum were lower than those in group A,and the differences were statistically significant(P<0.05).The number of Bifidobacteria in group C was higher than that in group A,and the difference was statistically significant(P<0.05),but it was still lower than that in groups B and D,and the differences were statistically significant(P<0.05).At the same time,the levels of HIF-1α,CRP and SIgA in group C were lower than those in group A,and the difference was statistically significant(P<0.05),but it was still higher than that in group B and D,and the differences were statistically significant(P<0.05).In terms of BASDAI,the scores of group B were lower than those of group A and group C,and the differences were statistically significant(P<0.05).Although the score of group C was lower than that of group A,the difference was not statistically significant(P>0.05).Conclusion Intestinal flora imbalance is common in AS patients,which is consistent with the high expression of HIF-1α,CRP,and SIgA in peripheral blood.Compared with traditional immunosuppressive therapy,by improving intestinal flora imbalance,the expression levels of HIF-1α,CRP and SIgA decrease after comprehensive treatment,and the BASDAI which reflects the degree of AS disease activity decrease too.It indicate that the improvement of intestinal flora imbalance has positive significance for improving the comprehensive efficacy of AS.