2型糖尿病合并肥胖患者肠道菌群分布及其与糖脂代谢和炎症指标的相关性

Distribution of intestinal flora and their correlation with glucose-lipid metabolism and inflammation indexes in patients with T2DM and obesity

目的分析2型糖尿病(T2DM)合并肥胖患者肠道菌群分布及其与糖脂代谢、炎症指标的相关性,为该类患者的治疗提供参考。方法选取2020年6月至2022年6月在我院就诊的120例T2DM合并肥胖患者作为研究组,另取同期120例单纯肥胖患者为肥胖组,120例健康成人作为对照组。比较各组对象肠道菌群(肠球菌、肠杆菌、乳杆菌、双歧杆菌、梭杆菌、拟杆菌和类杆菌)数量,糖、脂代谢指标[血清糖化血红蛋白(HbAlc)、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]和血清炎症指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)]水平。采用Pearson分析检测相关指标与肠道菌群数量的相关性。结果研究组患者肠道肠球菌[lg(8.02±0.26)CFU/g]和肠杆菌[lg(9.68±0.19)CFU/g]检出数量均高于肥胖组和对照组,同时肥胖组上述菌群数量均高于对照组(均P<0.05)。研究组患者肠道乳杆菌[lg(5.69±0.14)CFU/g]、双歧杆菌[lg(5.73±0.28)CFU/g]、梭杆菌[lg(6.01±0.25)CFU/g]、拟杆菌[lg(6.97±0.24)CFU/g]和类杆菌[lg(7.05±0.15)CFU/g]检出数量均低于肥胖组,同时肥胖组上述菌群数量均低于对照组(均P<0.05)。研究组患者血糖、血脂(TC、TG、LDL-C)和炎症指标水平均高于肥胖组,且肥胖组各指标水平高于对照组(均P<0.05)。研究组患者血清HDL-C水平低于肥胖组,且肥胖组低于对照组(P<0.05)。Pearson分析显示,肠球菌和肠杆菌数量与血糖、血脂(TC、TG)、炎症指标水平均呈正相关;乳杆菌、双歧杆菌、梭杆菌、拟杆菌和类杆菌数量与血糖、血脂(TC、TG)、炎症指标水平均呈负相关(均P<0.05)。结论T2DM合并肥胖患者肠道肠球菌、肠杆菌数量增加,乳杆菌、双歧杆菌、梭杆菌、拟杆菌、类杆菌数量降低,其变化与机体糖脂代谢和炎症状态有关。

Objective To analyze the distribution of intestinal floras and their correlation with glucose-lipid metabolism and inflammation indexes in patients with type 2 diabetes mellitus(T2DM)and obesity,providing a reference for the treatment.Methods A total of 120 patients with T2DM and obesity,120 patients with obesity alone and 120 healthy adults in our hospital were enrolled as the observation group,obesity group and control group between June 2020 and June 2022,respectively.The counts of intestinal floras(Enterococci,Enterobactesr,Lactobacillissus,Bifidobacteria,Fusobacteria,Bacteroidertes,Bacteroides),levels of serum glucose-lipid metabolism indexes[glycosylated hemoglobin(HbAlc),fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)]and inflammation indexes[interleukin-6(IL-6),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]were compared among groups.The correlation between the relevant indexes and intestinal floras was analyzed with Pearson analysis.Results The counts of Enterococci and Enterobacters were the highest in observation group,followed by obesity group and control group(all P<0.05),while the counts of Lactobacillus,Bifidobacteria,Fusobacteria,Bacteroidertes and Bacteroides were on the contrary(all P<0.05).The levels of blood glucose,blood lipids(TC,TG,LDL-C)and inflammation indexes were the highest in observation group,followed by obesity group and control group(all P<0.05),while the HDL-C level was on the contrary(all P<0.05).The results of Pearson analysis showed that the counts of Enterococci and Enterobacters were positively correlated with blood glucose,blood lipids(TC,TG)and inflammation indexes,while those of Lactobacillus,Bifidobacteria,Fusobacteria,Bacteroidertes and Bacteroides were negatively correlated with them(all P<0.05).Conclusion In patients with T2DM and obesity,the counts of Enterococci and Enterobacters increased,while those of Lactobacillus,Bifidobacteria,Fusobacteria,Bacteroidertes and Bacteroides decreased.The changes of intestinal floras are related to glucose-lipid metabolism and inflammatory status.