多囊卵巢综合征和输卵管阻塞不孕症患者肠道菌群特征分析

Characteristics of intestinal flora in infertile patients with polycystic ovary syndrome and tubal obstruction

目的 探讨多囊卵巢综合征(PCOS)和输卵管阻塞不孕症患者与健康育龄期女性肠道菌群特征之间的差异。方法 选择2020年9月至12月于兰州大学第一医院生殖中心就诊且符合纳入标准的30例不孕症患者为研究对象,分为PCOS不孕组(n=20)和输卵管阻塞不孕组(n=10),选择同期于兰州大学第一医院行备孕检查的健康育龄期女性作为健康对照组(n=10)。收集各组研究对象的新鲜粪便及血液样品,采用16S rRNA基因测序技术检测肠道菌群特征,并分析其与临床参数的关系。结果 在门水平,与健康对照组相比,PCOS不孕组和输卵管阻塞不孕组厚壁菌门相对丰度均降低(P均<0.05),PCOS不孕组拟杆菌门、变形菌门相对丰度均升高(P均<0.05);与输卵管阻塞不孕组相比,PCOS不孕组厚壁菌门相对丰度降低、变形菌门相对丰度升高(P均<0.05)。在PCOS不孕组,厚壁菌门与卵泡刺激素,拟杆菌门、变形菌门、放线菌门与总胆固醇,放线菌门与稳态模型胰岛素抵抗指数(HOMA-IR)均呈正相关(P均<0.05);厚壁菌门与总胆固醇、脱硫杆菌门与空腹血糖、梭杆菌门与HOMA-IR均呈负相关(P均<0.05)。在输卵管阻塞不孕组,弯曲菌门与黄体生成素/卵泡刺激素比值、未分类菌门与甘油三酯、厚壁菌门与雌二醇均呈正相关(P均<0.05);弯曲菌门与HOMA-IR、未分类菌门与腰臀比均呈负相关(P均<0.05)。结论 PCOS不孕和输卵管阻塞不孕症患者肠道菌群结构发生紊乱,且与糖、脂代谢相关。

Objective To investigate the differences in intestinal flora characteristics between infertile patients with polycystic ovary syndrome(PCOS) and tubal obstruction and healthy women of childbearing age. Methods A total of 30 female infertile patients, who met the inclusion criteria in Reproductive Medicine Center, The First Hospital of Lanzhou University from Sep. to Dec. 2020, were enrolled and divided into PCOS infertility group(n=20) and tubal obstruction infertility group(n=10). Healthy women of childbearing age who underwent prenatal testing in the same hospital during the same period were recruited as healthy control group(n=10). Fecal and blood samples were collected from each group of the participants, the characteristics of intestinal flora were detected by 16S rRNA gene sequencing, and their relationship with clinical parameters was analyzed. Results The relative abundance of Firmicutes in the PCOS infertility group and tubal obstruction infertility group were significantly decreased compared with the healthy control group at phylum level(both P<0.05), while the relative abundances of Bacteroidota and Proteobacteria were significantly increased in the PCOS infertility group(both P<0.05). Compared with the tubal obstruction infertility group, the relative abundance of Firmicutes was decreased and that of Proteobacteria was increased in the PCOS infertility group(both P<0.05). Firmicutes and folliclestimulating hormone(FSH), Bacteroidota, Proteobacteria, Actinobacteriota and total cholesterol(TC), and Actinobacteriota and homeostasis model assessment of insulin resistance(HOMA-IR) were all positively correlated in the PCOS infertility group(all P<0.05), while Firmicutes and TC, Desulfobacterota and fasting blood glucose(FBG), and Fusobacteriota and HOMA-IR were negatively correlated(all P<0.05). In the tubal obstruction infertility group, Campilobacterota and luteinizing hormone/FSH ratio, unidentified bacteria and triglyceride, and Firmicutes and estradiol were positively correlated(all P<0.05), while Campilobacterota and HOMA-IR, and unidentified bacteria and waist-hip-ratio were all negatively correlated(all P<0.05). Conclusion The composition of intestinal flora in infertility patients with PCOS and tubal obstruction is disordered and related to glucose and lipid metabolism.