肠道菌群与急性发作支气管哮喘患儿肺功能和气道炎症细胞的相关性分析

Correlation analysis of intestinal flora with lung function and airway inflammatory cells in children with acute bronchial asthma

目的:探讨肠道菌群与急性发作期支气管哮喘患儿肺功能和气道炎症的相关性。方法:选择2018年2月-2021年6月儿科病房收治的105例急性发作期支气管哮喘患儿为研究对象,根据哮喘急性发作严重程度分级,将患儿分为轻度组(36例)、中度组(42例)和重度组(27例)。另选择31例健康儿童为对照组。所有受试者均采集大便标本,荧光定量PCR检测肠道菌群相对丰度。比较各组肠道菌群状态,分析肠道菌群丰度与患儿肺功能和气道炎症细胞、炎症因子的关系。结果:重度组、中度组、轻度组乳酸杆菌、脆弱拟杆菌、毛螺菌、韦荣球菌、普拉梭菌和罗氏菌丰度低于对照组(P<0.001),且重度组低于中度组和轻度组(P<0.05);重度组、中度组、轻度组分节丝状菌、艰难梭菌丰度高于对照组(P<0.001),且重度组高于中度组和轻度组(P<0.05)。重度组第1秒用力呼气容积(FEV)、用力肺活量(FVC)、FEV/FVC、最大呼气峰流量(PEF)占正常预计值的百分率(PEF%)低于中度组和轻度组(P<0.05),诱导痰细胞总数、嗜酸粒细胞比例、肿瘤坏死因子-α(TNF-α)、IL-6高于中度组和轻度组(P<0.05)。支气管哮喘患儿乳酸杆菌、脆弱拟杆菌相对丰度与气道细胞总数、嗜酸粒细胞、TNF-α、IL-6呈负相关(r=-0.513、-0.493;-0.491、-0.401;-0.506、-0.477;-0.385、-0.401,均P<0.05),与FEV、FVC、FEV/FVC、PEF%呈正相关(r=0.477、0.395、0.362、0.509;0.394、0.305、0.293、0.411,均P<0.05);分节丝状菌、艰难梭菌相对丰度与气道细胞总数、嗜酸粒细胞、TNF-α、IL-6呈正相关(r=0.439、0.397;0.409、0.351;0.341、0.369;0.321、0.309,均P<0.05),与FEV、FVC、FEV/FVC、PEF%呈负相关(r=-0.413、-0.336、-0.274、-0.492;-0.369、-0.273、-0.391、-0.416,均P<0.05)。结论:急性发作期支气管哮喘患儿肠道菌群紊乱与肺功能降低、气道炎症细胞增加、炎症因子水平增高有关。

Objective:To investigate the relationship between intestinal flora and lung function and airway inflammation in children with acute bronchial asthma.Methods:One hundred and five patients with acute bronchial asthma treated in the pediatric inpatient ward of our hospital from February 2018 to June 2021 were selected.According totheseverityof acuteasthma attack,the children were divided into mild group(36 cases),moderate group(42 cases)and severe group(27 cases).Another 31 healthy children were selected as the control group.Stool samples were collected from all subjects,and the relative abundance of intestinal flora was detected by fluorescencequantitative PCR.The intestinal florastatusofeach group was comparedto analyze the relation ship between intestinal flora abundance and lung function and airway inflammatory cells and inflammatory cytokines Results:The abundance of Lactobacillus,Bacteroides fragilis,Spirillum tricillum,Verronococcus,Clostridium difficile and roche in severe,moderate and mild groupswas lower than that in control group(P<0.001),and the abundance of severe group were lower than that in moderate and mild groups(P<0.05).The abundance of Filamentous fungi and Clostridium difficile in severe group were higher than those in control group(P<0.001),and the abundance of severe group were higher than that in moderate and mild groups(P<0.05).The forced expiratory volume in the first second(FEV),forced critical capacity(FVC),FEV_(1)/FVC and maximum peak expiratory flow(PEF)%in the severe group were lower than those in the moderate and mild groups(P<0.05),while the total number of induced sputum cells and the proportion of eosinophil,the level of tumor necrosis factor-α(TNF-α)andinterleukin-6(IL-6)were higher than thosein the moderate and mild groups(P<0.05).The relative abundance of Lactobacillus and Bacteroides fragilis was negatively correlated with thetotal number of airwaycells,eosinophils,TNF-α and IL-6(r=-0.513,-0.493;-0.491,-0.401;-0.506,-0.477;-0.385,-0.401;P<0.05),were positively correlated with FEV_(1),FVC,FEV_(1)/FVC and PEF%(r=0.477,0.395,0.362,0.509;0.394,0.305,0.293,0.411,P<0.05);the relative abundance of Filamcinoma and Clostridium difficile were positively correlated with the total number of airway cells eosinophils,TNF-α and IL-6(r=0.439,0.397;0.409,0.351;0.341,0.369;0.321,0.309,P<0.05),and were negatively correlated with the FEV_(1),FVC,FEV_(1)/FVC and PEF%(r=-0.413,-0.336,-0.274,-0.492;-0.369,-0.273,-0.391,-0.416,P<0.05).Conclusion:Intestinal flora disorder in children with acute bronchial asthma is associated with decreased lung function and increased airway inflammatory cells and inflammatory cytokines.