慢传输型便秘和排便障碍型便秘患者肠道菌群结构分析

Analysis of Intestinal Flora Structure in Patients With Slow Transit Constipation and Functional Defecation Disorder Constipation

背景:功能性便秘(FC)是一种临床常见的胃肠道疾病,高发病率不仅影响患者的生命质量,还为医疗保健系统带来极大挑战。研究发现肠道菌群失调与便秘的发生、发展存在显著关联。目的:探讨慢传输型便秘(STC)患者和排便障碍型便秘(FDD)患者肠道菌群结构的组成和多样性。方法:选取2020年6月—2021年1月就诊于天津市人民医院的62例STC患者、87例FDD患者,以同期36名健康人作为对照(NC组)。采集所有受试者的粪便样本,以16S rRNA高通量测序技术分析肠道菌群结构。结果:Alpha多样性分析结果显示STC组、FDD组和NC组Chao、Ace、Shannon、Simpson指数无明显差异(P>0.05)。Beta多样性分析显示三组间肠道菌群结构存在显著差异(P=0.001)。物种差异分析结果显示,在门水平上,与NC组相比,STC组厚壁菌门丰度显著降低(P<0.001),拟杆菌门丰度显著升高(P<0.001),FDD组变形菌门丰度显著降低(P<0.05);与STC组相比,FDD组厚壁菌门和放线菌门丰度显著升高(P<0.001),拟杆菌门丰度显著降低(P<0.001)。在科水平上,与NC组相比,STC组、FDD组肠杆菌科丰度显著降低(P<0.05),STC组普雷沃菌科和拟杆菌科丰度显著升高(P<0.001),毛螺菌科丰度显著降低(P<0.001);与STC组相比,FDD组普雷沃菌科、拟杆菌科丰度显著降低(P<0.001),双歧杆菌科、毛螺菌科丰度显著升高(P<0.001)。在属水平上,STC组普雷沃菌属和拟杆菌属丰度显著高于FDD组和NC组(P<0.01,P<0.001),而双歧杆菌属和布劳特菌属丰度显著降低(P<0.05,P<0.001);与NC组相比,FDD组大肠埃希菌-志贺菌属和Dorea菌属丰度均显著降低(P<0.05)。结论:FDD患者菌群与正常人群构成基本相似,而STC患者存在厚壁菌门及其所属各级菌群丰度降低、拟杆菌门及其所属各级菌群丰度升高等菌群失调的现象。

Background:Functional constipation(FC)is a common clinical gastrointestinal disease.It affects the quality of life of patients and its high prevalence brings significant challenges to the healthcare system.Studies have shown that gut dysbiosis is closely associated with development of constipation.Aims:To investigate the diversity and composition of intestinal flora in patients with slow transit constipation(STC)and functional defecation disorder(FDD)constipation.Methods:A total of 62 STC,87 FDD patients from June 2020 to January 2021 at Tianjin Union Medical Center were enrolled,and 36 healthy subjects were served as controls(NC group).Stool was collected,the intestinal flora structure was analyzed by 16S rRNA high-throughput sequencing.Results:Alpha diversity analysis showed that no significant differences in Chao,Ace,Shannon,Simpson indices were found among STC group,FDD group and NC group(P>0.05),while Beta diversity analysis indicated that there was significant difference in the structure of intestinal flora among the three groups(P=0.001).Species difference analysis showed that at phylum level,abundance of Firmicutes was lower in STC group than in NC group(P<0.001),while abundance of Bacteroidetes was increased(P<0.001),and abundance of Proteobacteria was lower in FDD group than in NC group(P<0.05).Compared with STC group,abundances of Firmicutes and Actinobacteria in FDD group increased(P<0.001),and abundance of Bacteroidetes decreased(P<0.001).At family level,abundance of Enterobacteriaceae was lower in STC group and FDD group than in NC group(P<0.05).Abundances of Prevotellaceae and Bacteroidaceae were higher in STC group than in NC group(P<0.001),while abundance of Lachnospiraceae was lower(P<0.001).Abundances of Prevotellaceae,Bacteroidaceae in FDD group were significantly lower than those in STC group(P<0.001),while abundances of Bifidobacteriaceae and Lachnospiraceae were significantly higher(P<0.001).At the genus level,abundances of Prevotella and Bacteroides were higher in STC group than in FDD group and NC group(P<0.01,P<0.001),while abundances of Bifidobacterium,Blautia were lower(P<0.05,P<0.001).Abundances of Escherichia-Shigella and Dorea were lower in FDD group than in NC group(P<0.05).Conclusions:FDD patients and normal controls have similar intestinal flora structure.However,abundances of Firmicutes and its various flora levels decrease,and abundances of Bacteroides and its various flora levels increase in STC patients.