老年急性脑梗死患者肠道部分常见细菌分布及其与认知功能的相关性

Distribution of some common intestinal bacteria in elderly patients with acute cerebral infarction and its correlation with cognitive function

目的 了解老年急性脑梗死(ACI)患者肠道常见细菌分布情况,并分析其与认知功能的相关性。方法 选取2019年4月—2021年4月甘肃中医药大学第三附属医院93例老年ACI患者,均接受溶栓治疗,且至少随访6个月。根据是否发生认知功能障碍分为认知障碍组和认知正常组。收集2个组基线资料,比较2个组治疗前后肠道常见细菌分布。采用Logistic回归分析评价老年ACI患者肠道菌群与认知功能的相关性。采用受试者工作特征(ROC)曲线评价老年ACI患者肠道菌群预测认知功能障碍的价值。结果 93例老年ACI患者经溶栓治疗6个月后,发生认知功能障碍49例(52.69%)。认知障碍组肠道常见细菌中肠杆菌、肠球菌数量高于认知正常组,双歧杆菌、乳酸杆菌和消化球菌数量低于认知正常组(P<0.05)。Logistic回归分析结果显示,肠道中肠杆菌、肠球菌数量多是老年ACI患者发生认知障碍的危险因素[比值比(OR)值分别为1.777、1.689,P<0.05],双歧杆菌、乳酸杆菌、消化球菌数量多是老年ACI患者发生认知障碍的保护因素(OR值分别为0.213、0.242、0.409,P<0.05)。ROC曲线分析结果显示,老年ACI患者肠道中肠杆菌、肠球菌、双歧杆菌、乳酸杆菌和消化球菌数量预测老年ACI患者认知功能障碍的曲线下面积分别为0.722、0.803、0.830、0.730、0.722。结论 老年ACI患者认知功能与肠道部分常见细菌分布存在一定的关系,临床可根据实际情况拟定治疗方案,以改善患者预后。

Objective To observe the distribution of some common intestinal bacteria in elderly patients with acute cerebral infarction(ACI),and to analyze its correlation with cognitive function. Methods Totally,93elderly patients with ACI admitted to the Third Affiliated Hospital of Gansu University of Chinese Medicine from April 2019 to April 2021 were enrolled as research subjects,and they were followed up for at least 6 months after thrombolytic therapy,which were classified into cognitive impairment group and normal cognitive group. The baseline data were collected,the distribution of some common intestinal bacteria in the 2 groups before treatment was determined,and the correlation between some common intestinal bacteria’s distribution and cognitive function in elderly patients with ACI before treatment was analyzed. Results In 93 elderly patients with ACI at 6 months of follow-up after thrombolytic therapy,49 cases had cognitive impairment,the incidence rate was 52.69%. The numbers of Enterobacteriaceae and Enterococcus in cognitive impairment group were higher than those in normal cognitive group,and the numbers of Bifidobacterium,Lactobacillus and Peptococcus were lower than those in normal cognitive group(P<0.05). The results of Logistic regression analysis showed that a large number of Enterobacteriaceae and Enterococcus were risk factors for cognitive impairment in elderly patients with ACI [odds ratios(OR)were 1.777 and 1.689,P<0.05],a large number of Bifidobacterium,Lactobacillus and Peptococcus were protective factors for cognitive impairment in elderly patients with ACI(OR=0.213,0.242 and 0.409,P<0.05). Receiver operating characteristic(ROC) curve analysis showed that the areas under curves of the numbers of Enterobacteriaceae,Enterococcus,Bifidobacterium,Lactobacillus and Peptococcus before treatment in predicting cognitive impairment in elderly patients with ACI were 0.722,0.803,0.830,0.730 and 0.722,respectively,which had certain predictive value. Conclusions There is a correlation between cognitive function and the distribution of some common intestinal bacteria in elderly patients with ACI.