血尿酸与肠道菌群在不同严重程度冠心病患者中的关系

Relationship between blood uric acid and intestinal microflora in patients with coronary heart disease to different extents

目的探讨血尿酸与肠道菌群在不同严重程度冠状动脉粥样硬化性心脏病(冠心病,CHD)患者中的关系。方法选择新乡市中心医院(新乡医学院第四临床学院)于2018年1月至2020年12月收治的175例冠心病患者及50例同期门诊健康体检者为研究对象,根据冠心病的严重程度分为急性心肌梗死组(n=40)、不稳定型心绞痛组(n=42)、稳定型心绞痛组(n=43)、冠状动脉粥样硬化组(n=50)和对照组(n=50)。收集各组患者的临床资料并进行微生物检测,比较一般资料、血尿酸等指标的差异性和粪便肠道菌群情况,分析血尿酸与肠道菌群在不同严重程度冠心病患者中的相关性。结果各组间基本资料无显著性差异,冠心病患者的体质指数(BMI)、三酰甘油(TG)、总胆固醇(TC)、C-反应蛋白(CRP)、收缩压(SBP)、舒张压(DBP)与对照组比较有统计学差异(P<0.05)。急性心肌梗死组尿酸水平最高,明显高于不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组(P<0.05);急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组的尿酸水平显著高于健康人群(P<0.05);急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组的厚壁菌门明显高于对照组(P<0.05);急性心肌梗死组的厚壁菌门明显高于不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组(P<0.05);急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组的拟杆菌门明显低于对照组(P<0.05);急性心肌梗死组的拟杆菌门明显低于不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组(P<0.05);变形菌门和放线菌门在所有患者中无显著性差异(P>0.05)。急性心肌梗死组的梭杆菌门明显高于对照组(P<0.05)。急性心肌梗死组的大肠埃希菌、幽门螺杆菌、产气杆菌含量明显高于对照组(P<0.05);急性心肌梗死组的乳酸杆菌和双歧杆菌显著低于其余四组(P<0.05);急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组及冠状动脉粥样硬化组患者的大肠埃希菌、幽门螺杆菌、产气杆菌含量明显高于对照组(P<0.05);通过Pearson相关性分析显示尿酸水平与急性心肌梗死(r=0.72,P<0.05)、不稳定型心绞痛(r=0.46,P<0.05)、稳定型心绞痛(r=0.41,P<0.05)和冠状动脉粥样硬化(r=0.36,P<0.05)均具有相关性。急性心肌梗死组、不稳定型心绞痛组、稳定型心绞痛组患者中的尿酸水平与大肠埃希菌有相关性(分别为r=0.46,P<0.05;r=0.38,P<0.05;r=0.36,P<0.05),急性心肌梗死与幽门螺杆菌具有一定相关性(r=0.39,P<0.05)。结论不同疾病严重程度的冠心病患者肠道菌群结构改变,与尿酸水平升高有关,临床可采用肠道菌群结构和尿酸水平预估患者冠心病的严重程度,并可提供有效治疗方案。

Objective To investigate the relationship between blood uric acid(BUA)and intestinal microflora in patients with coronary heart disease(CHD)to different extents.Methods CHD patients(n=175)and healthy controls(n=50)were chosen from Central Hospital of Xinxiang City(the Fourth Clinical Medical School of Xinxiang Medical College)from Jan.2018 to Dec.2020.All cases were divided,according to CHD severity,into acute myocardial infarction group(AMI group,n=40),unstable angina pectoris group(UAP group,n=42),stable angina pectoris group(SAP group,n=43),coronary atherosclerosis(AC group,n=50)and control group(n=50).Clinical materials were collected and given microbial detections.The differences in general materials and BUA index,and intestinal microorganism in the stool were compared among all groups.The correlation between BUA and intestinal microorganism was analyzed in all groups.Results There was no significant difference in basic materials among all groups,and there were statistical differences in body mass index(BMI),triglyceride(TG),total cholesterol(TC),C-reactive protein(CRP),systolic blood pressure(SBP)and diastolic blood pressure(DBP)among control group and other groups(P<0.05).BUA level was the highest in AMI group,which was significantly higher than that in UAP group,SAP group and AC group(P<0.05).BUA level was significantly higher in AMI group,UAP group,SAP group and AC group than that in control group(P<0.05).The level of Firmicutes was significantly higher in AMI group,UAP group,SAP group and AC group than that in control group(P<0.05).The level of Firmicutes was significantly higher in AMI group than that in UAP group,SAP group and AC group(P<0.05).The level of Bacteroides was significantly lower in AMI group,UAP group,SAP group and AC group than that in control group(P<0.05).The level of Bacteroides was significantly lower in AMI group than that in UAP group,SAP group and AC group(P<0.05).Proteobacteria and Actinobacteria had no significant differences among all groups(P>0.05).The level of Fusobacterium was significantly higher in AMI group than that in control group(P<0.05).The levels of Escherichia coli,Helicobacter pylori and aerobacteria were significantly higher in AMI group than that in control group(P<0.05).The levels of lactobacillus and bifidobacterial were significantly lower in AMI group than those in other 4 groups(P<0.05).The levels of Escherichia coli,Helicobacter pylori and aerobacteria were significantly higher in AMI group,UAP group,SAP group and AC group than those in control group(P<0.05).The results of Pearson correlation analysis showed that BUA level was correlated to AMI(r=0.72,P<0.05),UAP(r=0.46,P<0.05),SAP(r=0.41,P<0.05)and AC(r=0.36,P<0.05).BUA level was correlated to Escherichia coli in AMI group(r=0.46,P<0.05),UAP group(r=0.38,P<0.05)and SAP group(r=0.36,P<0.05).AMI was correlated to Helicobacter pylori(r=0.39,P<0.05).Conclusion The changes of intestinal microorganism structure is related to BUA level increase in CHD patients to different extents.The severity of CHD can be predicted by detecting intestinal microorganism structure and BUA level in clinic for providing effective therapeutic plans.