肠道菌群对2型糖尿病肾病患者肾功能损害及白蛋白尿短期进展的影响

Effect of intestinal flora on renal function injury and short-term progression of albuminuria in patients with type 2 diabetic nephropathy

目的研究2型糖尿病肾病(DN)患者肠道菌群与肾功能损害及白蛋白尿短期进展的关系。方法选择2018年2月至2021年2月收治的2型DN患者作为DN组并分为微量白蛋白尿患者(30~300 mg/24 h)和大量白蛋白尿患者(>300 mg/24 h),另取同期收治的尿白蛋白水平正常(<30 mg/24 h)的2型糖尿病患者作为DM组,健康体检者作为对照组,检测各组对象肠道菌群多样性指标Ace指数、Simpson指数、Chao1指数、Shannon指数及肠道菌群门水平的组成,根据2型DN组患者前后2次入院时尿白蛋白水平的变划分为白蛋白尿短期进展和未进展,分析2型DN患者肠道菌群特征与病情及白蛋白尿短期进展的关系。结果DN组患者的肠道菌群Ace指数、Simpson指数及厚壁菌门占比均低于DM组和对照组,拟杆菌门占比高于DM组和对照组(均P<0.05),Chao1指数、Shannon指数以及放线菌门、变形菌门占比与DM组、对照组比较差异均无统计学意义(均P>0.05);DN组中大量白蛋白尿患者的Ace指数、Simpson指数及厚壁菌门占比低于微量白蛋白尿患者,拟杆菌门占比高于微量白蛋白尿患者(均P<0.05);DN组中白蛋白尿短期进展患者的Ace指数、Simpson指数及厚壁菌门占比低于未进展患者,拟杆菌门占比高于未进展患者(均P<0.05);DN组患者的Ace指数、Simpson指数以及厚壁菌门占比、拟杆菌门占比均对白蛋白尿短期进展具有预测价值。结论2型DN患者肠道菌群的多样性降低、厚壁菌门减少及拟杆菌门增多,肠道菌群的变化与病情加重和白蛋白尿短期进展有关。

Objective To explore the relationship of intestinal flora with renal function injury and short-term progression of albuminuria in patients with type 2 diabetic nephropathy(T2DN).Methods T2DN patients admitted to the hospital from February 2018 to February 2021 were selected as T2DN group and further divided into microalbuminuria patients(30-300 mg/24 hours)and macroalbuminuria patients(>300 mg/24 hours).Patients with type 2 diabetes with normal urinary albumin level(<30 mg/24 hours)were selected as DM group,with healthy individuals as control group.The intestinal flora diversity indexes Ace index,Simpson index,Chao1 index,Shannon index and composition of intestinal flora at phylum level were detected.According to the changes of urinary albumin level between two admissions,the T2DN patients were divided into short-term progression group and non progression group.The relationship of intestinal flora characteristics with disease condition and short-term progress of albuminuria in patients with T2DN was analyzed.Results The intestinal flora Ace index,Simpson index and proportion of Firmicutes in T2DN group were lower,while the proportion of Bacteroidota was higher than in DM group and control group,respectively(all P<0.05).There were no significant differences in Chao1 index,Shannon index,Actinomycetes and Proteus among T2DN group,DM group and control group(all P>0.05).In T2DN group,the Ace index,Simpson index and proportion of Firmicutes in patients with macroalbuminuria were lower,while the proportion of Bacteroidota was higher than those in patients with microalbuminuria,respectively(all P<0.05).In DN group,the Ace index,Simpson index and proportion of Firmicutes in patients with short-term progression of albuminuria were lower,while the proportion of Bacteroidota was higher than those without progression(all P<0.05).The Ace index,Simpson index,and proportions of Firmicutes and Bacteroidota in DN group had predictive value for the short-term progression of albuminuria.Conclusion The characteristics of intestinal flora in patients with T2DN include reduction of diversity,decrease of Firmicutes and increase of Bacteroidota.The change of intestinal flora is related to the aggravation of disease condition and short term progression of albuminuria.