复方嗜酸乳杆菌片对腹膜透析患者胃肠道症状的疗效及肠道菌群的影响

Effects of Compound Eosinophil-Lactobacillus Tablets on gastrointestinal symptoms and intestinal flora of patients received peritoneal dialysis

目的观察伴有胃肠道症状的腹膜透析患者口服复方嗜酸乳杆菌片治疗的效果,以及治疗前后肠道菌群的变化。方法回顾性选取2021年6至9月在杭州市中医院腹膜透析中心行持续性非卧床腹膜透析治疗并伴有胃肠道症状的患者40例。患者在常规治疗(降血压、调脂、降糖,以及纠正甲状旁腺功能亢进、电解质紊乱、贫血等)基础上联合口服复方嗜酸乳杆菌片治疗6个月。通过评估患者治疗前和治疗后胃肠道症状评定量表(GSRS)评分观察对胃肠道症状的疗效。收集患者治疗前后的粪便样本,采用16S核糖体DNA(16S rDNA)技术测定患者治疗前后肠道菌群多样性、物种组成差异。结果复方嗜酸乳杆菌片对患者胃肠道症状的治疗有效率分别为便秘80.6%,消化不良72.7%,腹痛82.6%,腹泻92.3%,反流72.7%,总体有效率为85.0%。消化不良、腹痛、腹泻、反流症群GSRS评分与特定肠道菌群在属水平丰度上均存在一定相关性(均P<0.05)。患者治疗前后肠道菌群的Alpha多样性及Beta多样性差异均有统计学意义(均P<0.05)。物种差异LEfSe分析提示肠道菌群在治疗前后共有2个门、3个纲、3个目、1个科、1个属、1个种的显著差异物种。细菌表型预测提示治疗后肠道菌群中好氧表型、耐应激性表型增加,厌氧表型下降。结论复方嗜酸乳杆菌片能改善腹膜透析患者胃肠道症状和肠道菌群失调。

Objective To observe the effect of oral Compound Eosinophil-Lactobacillus Tablets on patients with gastrointestinal symptoms who received peritoneal dialysis,and to analyze the changes in intestinal flora before and after treatment.Methods A retrospective study was conducted on 40 patients with gastrointestinal symptoms who underwent continuous ambulatory peritoneal dialysis treatment at the peritoneal dialysis center of Hangzhou Hospital of Traditional Chinese Medicine from June to September 2021.Patients were treated with oral Compound Eosinophil-Lactobacillus Tablets for 6 months on the basis of conventional treatment(blood pressure-,lipid-,and glucose-lowering,and correction of hyperparathyroidism,electrolyte disorders,anemia,etc.).The efficacy of gastrointestinal symptoms was evaluated using the Gastrointestinal Symptom Rating Scale(GSRS)scores before and after treatment.Fecal samples were collected before and after treatment,and 16S ribosomal DNA(16S rDNA)technology was used to determine the diversity and species of intestinal flora and compare their differences before and after treatment.Results The effective rates of Compound Eosinophil-Lactobacillus Tablets in the treatment of gastrointestinal symptoms were 80.6%for constipation,72.7%for dyspepsia,82.6%for abdominal pain,92.3%for diarrhea,and 72.7%for reflux,with an overall effective rate of 85.0%.A certain correlation was observed between the GSRS scores of dyspepsia,abdominal pain,diarrhea,and reflux and the abundance of specific intestinal flora at the genus level(all P<0.05).There were statistically significant differences in the Alpha diversity and Beta diversity of intestinal flora before and after treatment(both P<0.05).Species difference LDA Effect Size(LEfSe)analysis suggested that there were significant differences in 2 phyla,3 classes,3 orders,1 family,1 genus,and 1 species of intestinal flora before and after treatment.BugBase bacterial phenotype prediction showed that the aerobic phenotype and stress tolerance phenotype in the intestinal flora increased after treatment,while the anaerobic phenotype decreased.Conclusion Compound Eosinophil-Lactobacillus Tablets can improve gastrointestinal symptoms and intestinal flora imbalance in patients received peritoneal dialysis.