老年冠心病合并2型糖尿病患者血尿酸血脂水平对肠道菌群环境的影响

Serum uric acid and lipid levels on intestinal microflora environment in elderly patients with coronary heart disease

目的分析老年冠心病(coronary heart disease,CHD)合并2型糖尿病(T2DM)患者血尿酸、血脂水平对肠道菌群环境的影响,为老年CHD合并T2DM患者的治疗提供参考。方法实验组选取2020年1月至2021年1月来广东省中医院珠海医院治疗的老年CHD合并T2DM患者160例,患者年龄均>60岁,根据尿酸(UA)水平分为高尿酸组(n=62)和尿酸正常组(n=98),根据总胆固醇(TC)水平分为高胆固醇组(n=74)和血脂正常组(n=86),选择同期治疗的老年正常患者60例为对照组,均测定采用生化分析仪测定分析所有患者尿酸、低密度脂蛋白胆固醇(LDL-C)和总胆固醇(TC)水平,并且测定所有患者粪便标本中肠道菌群分布情况(双歧杆菌、乳杆菌、大肠埃希菌、幽门螺杆菌、链球菌);采用Spearman直线相关分析老年冠心病患者血尿酸、血脂水平和肠道菌群分布的相关性研究。结果实验组患者血清UA、LDL-C和TC水平明显高于对照组(P<0.05)。高胆固醇组乳酸杆菌和双歧杆菌明显低于血脂正常组,高胆固醇组大肠杆菌显著高于血脂正常组(P<0.05),两组幽门螺杆菌和链球菌间差异无统计学意义(P>0.05);高尿酸组双歧杆菌和乳酸菌明显低于尿酸正常组(P<0.05),高尿酸组大肠杆菌、幽门螺杆菌和链球菌显著高于尿酸正常组(P<0.05);Spearman相关分析显示UA与双歧杆菌和乳酸菌呈负相关,相关性系数为(r_(1)=-0.512,r_(2)=-0.439,P<0.05);UA与大肠杆菌、幽门螺杆菌和链球菌呈正相关,相关性系数为(r_(1)=0.491,r_(2)=0.396,r_(3)=0.218,P<0.05);Spearman相关分析显示TC与双歧杆菌和乳酸菌呈负相关,相关性系数为(r_(1)=-0.492,r_(2)=-0.427,P<0.05);TC与大肠杆菌呈正相关,相关性系数为(r=0.417,P<0.05);LDL-C与双歧杆菌和乳酸菌呈负相关,相关性系数为(r_(1)=-0.457,r_(2)=-0.404,P<0.05);LDL-C与大肠杆菌呈正相关,相关性系数为(r=0.404,P<0.05)。结论老年CHD合并T2DM患者存在肠道菌群分布异常,肠道菌群丰度与CHD合并T2DM患者的血脂、血尿酸水平具有一定的相关性。

Objective To analyze the effects of serum uric acid and lipid levels on intestinal microflora environment in elderly patients with coronary heart disease(CHD)combined with type 2 diabetes mellitus(T2DM),and to provide reference for the treatment of elderly patients with CHD combined with T2DM.Methods In the experimental group,160 elderly patients with CHD complicated with T2DM who were treated in our hospital from January 2020 to January 2021 were selected,all of whom were over 60 years old.According to the level of uric acid(UA),they were divided into high uric acid group(n=62)and normal uric acid group(n=98).According to the total cholesterol(TC)level,the patients were divided into high cholesterol group(n=74)and normal blood lipid group(n=86).Sixty elderly normal patients treated at the same time were selected as the control group.The levels of uric acid,low density lipoprotein cholesterol(LDL-C)and total cholesterol(TC)were determined and analyzed by biochemical analyzer.The distribution of intestinal flora(bifidobacteria,Lactobacillus,Escherichia coli,Helicobacter pylori,streptococcus)in stool samples of all patients was determined.Spearman linear correlation analysis was used to analyze the correlation between serum uric acid,lipid levels and intestinal microflora distribution in elderly patients with coronary heart disease.Results The serum LEVELS of UA,LDL-C and TC in experimental group were significantly higher than those in control group(P<0.05).Lactobacillus and bifidobacterium in high cholesterol group were significantly lower than those in normal blood lipid group,escherichia coli in high cholesterol group was significantly higher than that in normal blood lipid group(P<0.05),and there was no statistical significance in helicobacter pylori and streptococcus between the two groups(P>0.05).Bifidobacteria and lactobacillus in high uric acid group were significantly lower than those in normal uric acid group(P<0.05),escherichia coli,Helicobacter pylori and Streptococcus in high uric acid group were significantly higher than those in normal uric acid group(P<0.05).Spearman correlation analysis showed that UA was negatively correlated with bifidobacteria and lactobacillus,and the correlation coefficient was(r_(1)=-0.512,r_(2)=-0.439,P<0.05).UA was positively correlated with Escherichia coli,Helicobacter pylori and Streptococcus,with correlation coefficients(r_(1)=0.491,r_(2)=0.396,r_(3)=0.218,P<0.05).Spearman correlation analysis showed that TC was negatively correlated with bifidobacteria and lactobacillus,and the correlation coefficient was(r_(1)=-0.492,r_(2)=-0.427,P<0.05).TC was positively correlated with EScherichia coli(r=0.417,P<0.05).Ldl-c was negatively correlated with bifidobacterium and lactobacillus,and the correlation coefficient was(r_(1)=-0.457,r_(2)=-0.404,P<0.05).Ldl-c was positively correlated with EScherichia coli(r=0.404,P<0.05).Conclusions Elderly CHD patients with T2DM had abnormal intestinal flora distribution,and the abundance of intestinal flora was correlated with blood lipid and uric acid levels in CHD patients with T2DM.