中西医结合治疗肝衰竭对肠道微生态的影响研究

Effects of integrated traditional Chinese and Western medicine on intestinal microecology of liver failure

目的观察中西医结合方案治疗肝衰竭的临床疗效及其对肠道菌群丰度和多样性的影响。方法采用随机对照临床研究方法,将2019年6月至2020年12月在成都市公共卫生临床医疗中心住院治疗且符合条件的77例肝衰竭患者简单随机抽样分入试验组(39例)和对照组(38例),同时设健康对照组20例。试验组采用中西医结合治疗,对照组采用西医治疗,疗程4周,观察两组患者治疗前后肠道菌群丰度和多样性变化情况,以及与健康对照组肠道菌群的差异。结果与健康对照组相比,肝衰竭患者菌群丰度有显著差异(P<0.05),在门水平上厚壁菌门减少,变形菌门增加,在属水平上克雷伯氏菌属、链球菌属、埃希菌属等条件致病菌属增多。经β多样性分析,试验组治疗前后的肠道菌群多样性存在差异(P<0.05);经LEfSe分析,试验组治疗后患者肠道乳酸杆菌等有益菌的相对丰度升高,克雷伯氏菌属、埃希菌属等条件致病菌属的相对丰度降低。结论肝衰竭患者存在肠道微生态紊乱,表现为条件致病菌增多、有益菌减少,经中西医结合治疗可提高肠道乳酸杆菌等有益菌相对丰度、降低条件致病菌属相对丰度,改善肠道微生态。

Objective To observe the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of liver failure and its influence on the abundance and diversity of intestinal microbiota.Method In a randomized controlled clinical study,77 patients with liver failure who were hospitalized at Chengdu Public Health Clinical Medical Center from June 2019 to December 2020 were randomly divided into experimental group(39 cases)and control group(38 cases),20 healthy control groups were also established.The experimental group was treated with integrated Traditional Chinese and Western medicine,and the control group was treated with western medicine.The course of treatment was 4 weeks.The changes of intestinal flora abundance and diversity before and after treatment were observed in the two groups.Result Compared with healthy control group,the abundance of bacteria in patients with liver failure was significantly different(P<0.05).Firmicutes decreased and proteobacteria increased at phylum level,and Klebsiella,Streptococcus and Eschia increased at phylum level.β-diversity analysis showed that there was a difference in intestinal microbiota diversity before and after treatment in experimental groups(P<0.05).The LEfSe analysis showed that after treatment,the relative abundance of beneficial bacteria such as lactobacillus increased,while the relative abundance of opportunistic pathogens such as Klebsiella and Escherichia decreased in the experimental group.Conclusion Patients with liver failure have intestinal microecology disorder,which is manifested by the increase of conditional pathogenic bacteria and the decrease of beneficial bacteria.After treatment with integrated Traditional Chinese and Western medicine,the relative abundance of beneficial bacteria such as lactobacillus can be increased,the relative abundance of conditional pathogenic bacteria can be reduced,and the intestinal micro-ecology can be improved.