冠脉搭桥术后患者肠道菌群变化与免疫失衡的关系及对预后评估价值

The relationship between the changes of intestinal flora and immune imbalance in patients after coronary artery bypass grafting and its prognostic value

目的探究冠脉搭桥术后患者肠道菌群变化与免疫失衡的关系及对预后评估的价值,为冠心病患者的治疗和预后评估提供新思路。方法回顾性分析2019年1月至2022年2月我院收治的88例冠脉搭桥术后冠心病患者。根据患者1年内是否发生主要不良心脏事件划分为短期预后良好组(n=70)和短期预后不良组(n=18)。对比两组患者肠道菌群丰度,血清氧化三甲胺(TMAO)、乙酸、丙酸及丁酸等肠道菌群代谢产物水平,血清白细胞介素6(IL-6)、白细胞介素8(IL-8)、单核细胞趋化蛋白-1(MCP-1)及肿瘤坏死因子α(TNF-α)水平。通过相关性分析和二元Logistic回归分析筛选患者预后不良的危险因素,通过受试者工作曲线及曲线下面积(AUC)评价各危险因素的预测价值。结果短期预后不良组患者粪便肠杆菌属和埃希菌属的丰度以及血清TMAO、乙酸、IL-6、MCP-1、TNF-α的水平均显著高于短期预后良好组患者(t=3.325、2.366、3.643、3.050、3.147、2.847、4.220,均P<0.05)。相关性分析和二元Logistic回归分析表明血清TMAO、IL-6及TNF-α水平升高均是患者不良预后的独立危险因素(OR=1.769、1.312、1.532,均P<0.05)。各独立危险因素对于患者预后不良均具有较高预测效能,其中血清TMAO、IL-6及TNF-α三者联合的预测价值最高(AUC=0.883,P<0.05)。结论不同预后的冠脉搭桥术后患者肠道菌群丰度、肠道菌群代谢产物及免疫炎症因子水平均存在一定差异,其中TMAO、IL-6及TNF-α对患者不良预后具有较高预测价值,对于更好地评价冠脉搭桥术后患者预后具有一定临床价值。

Objective To explore the relationship between the changes of intestinal flora and immune imbalance in patients after coronary artery bypass grafting(CABG)and its value in evaluating the prognosis.Methods A total of 88 patients with coronary heart disease after CABG in our hospital from January 2019 to February 2022 were analyzed retrospectively.According to the occurrence of major adverse cardiac events within one year,the patients were divided into two groups:good short-term prognosis group(n=70)and poor short-term prognosis group(n=18).The abundance of intestinal microflora,the levels of serum trimethylamine oxide(TMAO),acetic acid,propionic acid and butyric acid,and the levels of serum interleukin-6(IL-6),interleukin-8(IL-8),monocyte chemoattractant protein-1(MCP-1)and tumor necrosis factorα(TNF-α)were compared between the two groups.The risk factors of poor prognosis were screened by using correlation analysis and binary Logistic regression analysis,and the predictive value of each risk factor was evaluated with receiver working curve and area under curve(AUC).Results The abundances of fecal Enterobacter and Escherichia coli and levels of serum TMAO,acetic acid,IL-6,MCP-1 and TNF-αin the patients with poor short-term prognosis were significantly higher than those with good short-term prognosis(t=3.325,t=2.366,t=3.643,t=3.050,t=3.147,t=2.847,t=4.220;all P<0.05).Correlation analysis and binary Logistic regression analysis showed that the elevated levels of serum TMAO,IL-6 and TNF-αwere independent risk factors for poor prognosis(OR=1.769,OR=1.312,OR=1.532;all P<0.05).All the independent risk factors had high predictive power for poor prognosis,and the predictive value of serum TNF-αcombined with IL-6 and TMAO was the highest(AUC=0.883,P<0.05).Conclusion There are some differences in intestinal flora abundance,intestinal flora metabolites and immune inflammatory factors among patients with different prognosis after CABG,among which TMAO,IL-6 and TNF-αhave high predictive value for poor prognosis and have certain clinical value for better evaluation of prognosis after CABG.