2型糖尿病患者应用抗菌素和微生态制剂对肠道菌群变化的影响

Effects of antibiotics and microecological agents on changes of intestinal flora in patients with type 2 diabetes mellitus

目的 分析抗菌素和微生态制剂对2型糖尿病(T2DM)患者肠道菌群变化的影响。方法 选取118例糖尿病合并肠道菌群失调患者作为糖尿病(DM)组,其中由于病情需要使用抗菌素治疗的患者84例,不使用抗菌素治疗的患者34例;84例使用抗菌素治疗的患者中,有45例同时给予微生态制剂治疗,其余39例未应用微生态制剂治疗。另选取106例进行体检的健康者作为非DM组。比较两组肠道菌群, DM组中单纯应用抗菌素治疗以及应用抗菌素联合微生态制剂治疗患者治疗前后的肠道菌群。结果 DM组患者肠杆菌(9.52±0.75)logN/g显著高于非DM组的(9.13±0.78)logN/g,双歧杆菌(7.01±1.84)logN/g、乳杆菌(6.74±2.85)logN/g及双歧杆菌和肠杆菌比值(B/E)(0.74±0.19)显著低于非DM组的(8.30±2.16)logN/g、(7.50±2.35)logN/g、(0.91±0.28),差异均具有统计学意义(P<0.05)。DM组中单纯采用抗菌素治疗患者治疗10 d的肠杆菌、肠球菌水平均低于治疗前,治疗10、15 d的拟杆菌、双歧杆菌、乳杆菌水平均低于治疗前及治疗5 d;治疗15 d的拟杆菌、双歧杆菌及乳杆菌水平低于治疗10 d;差异具有统计学意义(P<0.05)。治疗前、治疗5 d、治疗10 d,肠杆菌、肠球菌水平呈下降趋势,治疗10~15 d呈上升趋势;拟杆菌、双歧杆菌、乳杆菌水平则随治疗时间的延长呈逐渐下降趋势,且治疗10、15 d时其下降显著。DM组中应用抗菌素联合微生态制剂治疗患者治疗5、10、15 d的肠杆菌水平低于治疗前,肠球菌水平高于治疗前;治疗5 d的拟杆菌、双歧杆菌水平高于治疗前;治疗15 d的拟杆菌水平低于治疗前;治疗10、15 d的双歧杆菌和乳杆菌水平低于治疗前;差异均具有统计学意义(P<0.05)。结论 2型糖尿病患者存在肠道菌群失调的问题,抗菌素治疗会引起益生菌减少,肠杆菌先降后升,同时应用微生态制剂干预可部分逆转抗菌素引起的肠道菌群失调,但随着抗菌素应用时间的延长,微生态制剂对肠道菌群调节作用逐渐减弱。

Objective To analyze the effects of antibiotics and microecological agents on changes of intestinal flora in patients with type 2 diabetes mellitus(T2DM).Methods A total of 118 patients with type 2 diabetes mellitus complicated with intestinal flora imbalance were selected as diabetes mellitus(DM)group,of which 84 patients needed to be treated with antibiotics and 34 patients did not use antibiotics.Among the 84 patients treated with antibiotics,45 patients were treated with microecological agents and the remaining 39 patients were not treated with microecological agents.Another 106 healthy subjects who underwent physical examination were selected as the non-DM group.The intestinal flora of DM group and non-DM group were compared,and the intestinal flora of patients treated with antibiotics alone or treated with antibiotics combined with microecological agents before and after treatment in DM group were analyzed.Results Enterobacter of(9.52±0.75)logN/g in DM group was significantly higher than that of(9.13±0.78)logN/g in non-DM group;bifidobacterium of(7.01±1.84)logN/g,lactobacillus of(6.74±2.85)logN/g and bifidobacteria-enterobacterium ratio(B/E)of(0.74±0.19)logN/g in DM group were significantly lower than those of(8.30±2.16),(7.50±2.35)and(0.91±0.28)logN/g in non-DM group;the differences were statistically significant(P<0.05).In DM group,the levels of enterobacter and enterococcus in patients treated with antibiotics alone for 10 d were lower than those before treatment;the levels of bacteroides,bifidobacterium and lactobacillus after 10 and 15 d of treatment were lower than those before treatment and after 5 d of treatment;the levels of bacteroides,bifidobacterium and lactobacillus after 15 d of treatment were lower than those after 10 d of treatment;the differences were statistically significant(P<0.05).Before treatment and after 5 and 10 d of treatment,the levels of enterobacter and enterococcus showed a decreasing trend,and increased after 10-15 d of treatment;the levels of bacteroides,bifidobacterium and lactobacillus decreased gradually with the extension of treatment time,and the decrease was significant after 10 and 15 d of treatment.In DM group,the level of enterobacter after 5,10 and 15 d of treatment was lower than that before treatment,and the level of enterococcus was higher than that before treatment;the levels of bacteroides and bifidobacterium after 5 d of treatment were higher than those before treatment;the level of bacteroides after 15 d of treatment was lower than that before treatment;the levels of bifidobacterium and lactobacillus after 10 and 15 d of treatment were lower than those before treatment;the differences were statistically significant(P<0.05).Conclusion Type 2 diabetes mellitus patients have the problem of intestinal flora imbalance.Antibiotic treatment will cause the decrease of probiotics,and the enterobacter will first fall and then rise.At the same time,the intervention of microecological agents can partially reverse the imbalance of intestinal flora caused by antibiotics.However,with the extension of the application of antibiotics,the regulatory effect of microecological agents on intestinal flora will gradually weaken.