冠心病患者糖脂代谢与肠道菌群平衡的关系

The relationship between glucolipid metabolism and intestinal flora balance in patients with coronary heart disease

目的 研究冠心病(CHD)患者糖脂代谢与肠道菌群平衡的关系,为该类患者的治疗提供参考。方法 选择2020年4月至2021年4月我院收治的79例CHD患者(CHD组)和82例健康体检者(对照组)为研究对象进行横断面研究。详细采集两组对象一般资料,同时完成体格检查和生命体征检测并计算体质量指数(BMI)。采集两组对象入组第1天时空腹外周静脉血,检测空腹血糖(FPG)和空腹胰岛素(FINS)水平并计算稳态模型胰岛素抵抗指数(HOMA-IR),检测血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)等脂质代谢指标水平。收集两组研究对象新鲜晨便并采用荧光定量PCR法检测肠道双歧杆菌、乳杆菌、拟杆菌、梭菌和白假丝酵母数量。比较两组对象基本资料、糖脂代谢指标和肠道菌群分布,分析CHD患者肠道菌群与糖脂代谢指标相关性。结果 CHD组患者HOMA-IR(t=2.729,P=0.007)和血清TC(t=2.915,P=0.030)、TG(t=2.567,P=0.011)水平显著高于对照组,血清LDL-C(t=2.129,P=0.035)水平显著低于对照组。CHD组患者肠道双歧杆菌数量(t=2.247,P=0.026)和拟杆菌/梭菌比值(t=2.111,P=0.036)低于对照组。CHD患者肠道双歧杆菌数量和拟杆菌/梭菌比值与HOMA-IR(r=-0.384、-0.354,P<0.001、=0.012)以及血清TC(r=-0.361、-0.329,P=0.005、0.027)、TG(r=-0.358、-0.341,P=0.009、0.020)和LDL-C(r=-0.326、-0.317,P=0.031、0.038)水平均呈显著负相关。结论 CHD患者糖脂代谢和肠道菌群分布均存在显著异常,且HOMA-IR、血清TC、TG和LDL-C水平均与肠道双歧杆菌数量和拟杆菌/梭菌比值呈负相关,因此对肠道菌群进行检测和合理干预有利于调节糖脂代谢。

Objective To study the relationship between glucolipid metabolism and intestinal flora balance in patients with coronary heart disease(CHD), and provide a reference for the treatment of these patients. Methods A total of 79 patients with CHD(CHD group) and 82 healthy subjects with physical examination(control group) between April 2020 and April 2021 were enrolled for cross-sectional study. General data of the two groups were collected in detail;physical examination and vital signs detection were completed, and body mass index(BMI) was calculated. Fasting peripheral venous blood were collected on the 1day of entry, and the levels of fasting plasma glucose(FPG) and fasting insulin(FINS) were detected. The homeostasis model assessment of insulin resistance(HOMA-IR) was calculated, and the expression levels of lipid metabolism indicators such as serum total cholesterol(TC), triacylglycerol(TG), high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholesterol(LDL-C) were measured. Fresh morning feces were collected, and fluorescence quantitative PCR was used to measure the counts of Bifidobacterium, Lactobacillus, Bacteroides, Escherichia coli and Candida albicans. The basic data, glucolipid metabolism indicators and intestinal flora distribution were compared between the two groups, and the correlation between intestinal flora and glucolipid metabolism indicators was analyzed among the patients with CHD. Results The HOMA-IR(t=2.729, P=0.007) and levels of serum TC(t=2.915, P=0.030) and TG(t=2.567, P=0.011) in CHD group were significantly higher, while the level of serum LDL-C(t=2.129, P=0.035) was significantly lower than in control group. The count of Bifidobacterium(t=2.247, P=0.026) and ratio of Bacteroides/Fusobacterium(t=2.111, P=0.036) in CHD group were lower than those in control group respectively. The count of intestinal Bifidobacterium and ratio of Bacteroides/Fusobacterium of patients with CHD were significantly negatively correlated with HOMA-IR(r=-0.384,-0.354;P<0.001, =0.012), serum TC(r=-0.361,-0.329;P=0.005, 0.027), TG(r=-0.358,-0.341;P=0.009, 0.020) and LDL-C(r=-0.326,-0.317;P=0.031, 0.038). Conclusion There are significant abnormalities in glucolipid metabolism and intestinal flora distribution among patients with CHD, and HOMA-IR and levels of serum TC, TG and LDL-C are negatively correlated with the count of intestinal Bifidobacterium and ratio of Bacteroides/Fusobacterium. Therefore, the detection and reasonable intervention of intestinal flora are beneficial to the regulation of glucolipid metabolism.