溃疡性结肠炎合并艰难梭菌感染患者肠道菌群多样性及代谢特征分析

Analysis of intestinal flora diversity and metabolic characteristics in patients with ulcerative colitis complicated with clostridium difficile infection

目的 分析溃疡性结肠炎合并艰难梭菌感染患者肠道菌群多样性及其对糖脂代谢的影响。方法 选取2018年1月—2021年12月海南医学院第一附属医院消化科诊治合并艰难梭菌感染的溃疡性结肠炎患者84例为感染组,并选取同期活动期溃疡性结肠炎患者91例(未感染组)及非溃疡性结肠炎患者104例(对照组),比较3组患者的临床资料、糖脂代谢指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)]、肠道菌群多样性(Chao1指数、Ace指数、Simpson指数、Shannon指数)及分布差异,Spearman法分析代谢指标与差异菌群多样性的相关性。结果 血清TC、TG水平比较,感染组<未感染组<对照组(F/P=20.051/<0.001,26.321/<0.001);Chao1指数、Ace指数及Shannon指数比较,感染组<未感染组<对照组(F/P=176.245/<0.001,254.463/<0.001,247.447/<0.001),而Simpson指数比较,感染组>未感染组>对照组(F/P=105.363/<0.001)。与对照组比较,未感染组患者志贺菌属及埃希菌属丰度更高,双歧杆菌属、乳酸杆菌属、拟杆菌属、真杆菌属丰度降低(LDA>2log10,P<0.05);与未感染组比较,感染组中拟杆菌属、变形杆菌属、梭状芽胞杆菌属及芽孢杆菌属丰度升高,副拟杆菌属及柠檬酸杆菌属丰度降低(LDA>2log10,P<0.05)。相关性分析显示,溃疡性结肠炎合并艰难梭菌感染患者Chao 1指数、Ace指数、Shannon指数与TC、TG水平呈正相关(TC:r/P=0.614/<0.001,0.584/<0.001,0.592/<0.001;TG:r/P=0.604/<0.001,0.587/<0.001,0.591/<0.001),而Simpson指数与TC、TG水平呈负相关(r/P=-0.601/<0.001,-0.593/<0.001)。结论 合并艰难梭菌感染的溃疡性结肠炎患者肠道菌群发生改变,且菌群多样性与患者脂质代谢相关。

Objective To analyze the diversity of intestinal flora in patients with ulcerative colitis complicated with clostridium difficile infection and its influence on glucose and lipid metabolism. Methods From January 2018 to December 2021, 84 patients with ulcerative colitis complicated with clostridium difficile infection were selected as the infection group, and 91 patients with active ulcerative colitis(non-infected group) and 104 patients with non-ulcerative colitis(control group) were selected for the same period. The clinical data, glycolipid metabolism index(total cholesterol(TC), triacylglycerol(TG) Low density lipoprotein cholesterol(LDL-C), high density lipoprotein cholesterol(HDL-C), fasting blood glucose(FPG)), intestinal microflora diversity(Chao1 index, Ace index, Simpson index, Shannon index) and distribution differences. Spearman method was used to analyze the correlation between metabolic indicators and the diversity of different microflora. Results Compared with the serum TC and TG levels, the infected group was lower than the non-infected group and lower than the control group(F/P=20.051/<0.001, 26.321/<0.001). Compared with the Chao1 index, Ace index and Shannon index, the infected group was lower than the non-infected group than the control group(F/P=176.245/<0.001, 254.463/<0.001, 247.447/<0.001), while the Simpson index was higher than the non-infected group than the control group(F/P=105.363/<0.001). Compared with the control group, the abundance of Shigella and Escherichia in the non-infected group was higher, and bifidobacteria, lactobacillus, Bacteroides and Eubacterium were decreased(LDA>2log10,P<0.05). Compared with non-infected group, Bacteroides, Proteus, Clostridium and Bacillus increased in the infected group, while the abundance of Bacteroides and Citrobacter decreased(LDA>2log10,P<0.05). The correlation analysis showed that the Chao 1 index, Ace index and Shannon index of patients with ulcerative colitis complicated with clostridium difficile infection were positively correlated with the levels of TC and TG(TC:r/P=0.614/<0.001,0.584/<0.001,0.592/<0.001;TG:r/P=0.604/<0.001, 0.587/<0.001, 0.591/<0.001), while Simpson index is negatively correlated with TC and TG levels(r/P=-0.601/<0.001,-0.593/<0.001). Conclusions The intestinal flora of patients with ulcerative colitis complicated with clostridium difficile infection has changed, and the diversity of flora is related to the lipid metabolism of patients.