冠心病合并糖尿病患者肠道菌群特点及与冠脉粥样硬化的相关性

Characteristics of intestinal flora in patients with coronary heart disease complicated with diabetes and its correlation with coronary atherosclerosis

目的 探讨冠心病合并糖尿病患者肠道菌群特点及与冠脉粥样硬化的相关性。方法 采用回顾性研究方法,选取2019年1月至2022年2月在上海市第十人民医院治疗的冠心病患者122例,其中合并2型糖尿病患者51例。根据有无合并糖尿病分为有糖尿病组(n=51)和无糖尿病组(n=71),有糖尿病组根据冠状动脉病变程度分为轻中度组(n=24)和重度组(n=27)。分析有无糖尿病患者临床资料、肠道菌群及血清氧化三甲胺(TMAO)差异,比较冠状动脉不同病变程度伴糖尿病患者临床资料、肠道菌群、TMAO的差异,同时分析空腹血糖、糖化血红蛋白(HbA1c)、Gensini积分与肠道菌群及血清TMAO的相关性。结果 有糖尿病组患者体重指数、冠状动脉重度病变比例、Gensini评分、总胆固醇、甘油三酯和低密度脂蛋白胆固醇分别为(24.80±2.11) kg/m2、52.94%、(42.03±8.84)分、(4.81±0.94) mmol/L、(2.30±0.81) mmol/L和(3.10±0.97) mmol/L,明显高于无糖尿病组,而高密度脂蛋白胆固醇为(1.01±0.30) mmol/L,明显低于无糖尿病组,差异均有统计学意义(P<0.05)。有糖尿病组患者乳酸菌属丰度、双歧杆菌属丰度分别为(3.02±0.84)和(215.56±90.11),明显低于无糖尿病组,而埃希菌属丰度、大肠杆菌属丰度、TMAO分别为(410.41±61.11)、(35.51±4.11)和(6.61±1.01)μmol/L,明显高于无糖尿病患者,差异均有统计学意义(P<0.05)。重度组冠状动脉病变伴糖尿病患者空腹血糖、HbA1c和TMAO分别为(8.21±1.05)mmol/L、(7.51±0.82)%和(7.13±0.91)μmol/L,明显高于轻中度组,差异均有统计学意义(P<0.05)。空腹血糖、HbA1c与乳酸菌属丰度、双歧杆菌属丰度呈负相关(P<0.05),而与埃希氏菌属丰度、大肠杆菌属丰度、TMAO呈正相关(P<0.05)。Gensini评分与TMAO呈正相关(P<0.05)。结论 冠心病合并糖尿病患者肠道乳酸菌属和双歧杆菌属降低,而埃希菌属丰度和大肠杆菌属升高,其中患者血糖水平与肠道菌群数量呈相关性,血清TMAO与冠状动脉病变程度有相关性。

Objective To explore the characteristics of intestinal flora in patients with coronary heart disease complicated with diabetes and its correlation with coronary atherosclerosis. Methods Retrospective research methods was used, 122 patients with coronary heart disease treated in Shanghai Tenth People’s Hospital from January 2019 to February 2022, including 51 patients with type 2 diabetes. They were divided into diabetes group(n=51) and diabetes free group(n=71) according to whether they had diabetes or not. The diabetes group was divided into mild to moderate(n=24) and severe(n=27) according to the degree of coronary artery disease. The clinical data, intestinal flora and serum trimethylamine oxide(TMAO) differences in patients with or without diabetes, the differences of clinical data, intestinal flora and TMAO in patients with diabetes with different coronary artery lesions were compared, and the correlation between fasting plasma glucose(FPG), glycosylated hemoglobin(HbA1c), Gensini score and intestinal flora and serum TMAO. Results The body mass index, the proportion of severe coronary artery disease, Gensini score, total cholesterol, triglyceride and low density lipoprotein cholesterol of patients with diabetes were(24.80±2.11) kg/m~2, 52.94%,(42.03±8.84) points,(4.81±0.94) mmol/L,(2.30±0.81) mmol/L and(3.10±0.97) mmol/L, respectively, which were significantly higher than those without diabetes(P<0.05), high density lipoprotein cholesterol was(1.01±0.30) mmol/L, which was significantly lower than that in patients without diabetes, the differences were statistically significant(P<0.05). The abundance of Lactobacillus and Bifidobacterium in patients with diabetes were(3.02±0.84) and(215.56±90.11) respectively, which were significantly lower than those in patients without diabetes while the abundance of Escherichia coli, Escherichia coli and TMAO were(410.41±61.11),(35.51±4.11) and(6.61±1.01) mol/L, which were significantly higher than those in patients without diabetes, the differences were statistically significant(P<0.05). FPG, HbA1c and TMAO in patients with severe coronary artery disease and diabetes were(8.21±1.05) mmol/L,(7.51±0.82)% and(7.13±0.91) mol/L, respectively, which was significantly higher than those in patients with mild to moderate coronary artery disease and diabetes, the differences were statistically significant(P<0.05). FPG and HbA1c were negatively correlated with the abundance of Lactobacillus and Bifidobacterium(P<0.05), but positively correlated with the abundance of Escherichia coli, Escherichia coli and TMAO(P<0.05). Gensini score was positively correlated with TMAO(P<0.05). Conclusion In patients with coronary heart disease and diabetes, the intestinal lactic acid bacteria and bifidobacteria decrease, while the abundance of Escherichia coli and Escherichia coli increase, among them, the blood glucose level of patients is correlated with the number of intestinal flora, and serum TMAO is correlated with the degree of coronary artery disease.