玉屏风加苍耳子散加减方对反复呼吸道感染患儿肠道菌群的影响

Regulatory effect of Yupingfeng Plus Cang'erzi San Decoction on gut microbiota in children with recurrent respiratory tract infection

目的研究玉屏风加苍耳子散加减方(YCD)对反复呼吸道感染(RRTI)患儿肠道菌群的影响。方法 选取2018-2019年我院3~6岁11例RRTI患儿,随机分为YCD治疗组6例,泛福舒(OM-85)治疗对照组5例,分别收取治疗前、治疗2周、治疗4周和治疗3月的粪便,同时选取同年龄段的44例健康儿童作为正常对照组并收取粪便。所有标本进行16S rDNA高通量测序,分析YCD和OM-85治疗RRTI患儿病情变化与肠道菌群变化的相关性并预测菌群功能。结果 YCD治疗RRTI患儿4周至3月的疗效好于OM-85(P<0.05)。RRTI患儿与正常儿童的肠道菌群组成结构有显著差异(P<0.001)。RRTI患儿肠道菌群在治疗前后菌群丰富度和多样性均高于正常儿童(P> 0.05),但治疗后的组间差异均较治疗前减小(P>0.05)。YCD治疗前后的拟杆菌门、放线菌门和拟杆菌属、嗜血杆菌属、梭菌ⅩⅣa属、副拟杆菌属、芽殖菌属的相对丰度变化与YCD疗效规律协同并与功能代谢通路相关(r>0.5,P<0.001)。其中,拟杆菌属、副拟杆菌属和芽殖菌属分别为治疗4周和3月的核心菌属。结论 YCD可以调节RRTI患儿肠道菌群失衡来改善患儿病情,尤其在疾病后期为RRTI患儿的防治提供新思路。

Objective To explore the effect of Yupingfeng Plus Cang’erzi San Decoction(YCD) on gut microbiota in children with recurrent respiratory tract infection(RRTI). Methods A total of 11 RRTI children aged 3 to 6 were randomly allocated to receive YCD(n=6) or OM-85(n=5);44 healthy children were selected as normal controls. The gut microbiota of the subjects were examined at pre-teatment, 2 weeks, 4 weeks and 3 months of treatment by using pyrosequencing of 16S r RNA genes. Results YCD had a better therapeutic effect on RRTI than OM-85 at 4 weeks to 3 months of treatment(P<0.05). There were obvious differences between RRTI children and healthy children based on β-diversity analysis(P<0.001). The childen with RRTI presented higher bacterial richness and diversity than healthy children at both pre-and post-treatment(P> 0.05), whereas the differences in microbiota structures and compositions reduced after treatment(P>0.05). YCD was associated with the changes of relative abundance of Bacteroidetes and Actinobacteria at phylum level as well as the potential biomarkers of Bacteroides, Haemophilus, Clostridium Ⅹ Ⅳ a, Parabacteroides and Gemmiger at genus level. The potential biomarkers revealed a significant correlation with metabolic pathway(r>0.5, P<0.001), particularly the core bacteria of Bacteroides, Parabacteroides and Gemmiger at 4 weeks and 3 months of treatment, respectively. Conclusion YCD can improve intestinal microbiota dysbiosis in childen with RRTI to alleviate RRTI, especially in advanced stages, which provides a new way to prevent and treat RRTI in childen.