慢性肾脏病血液透析患者血管钙化、死亡风险和肠道微生物组之间的潜在联系

Potential relationship between vascular calcification,death risk and intestinal microbiota in hemodialysis patients with chronic kidney disease

目的 初步分析慢性肾脏病(CKD)血液透析患者血管钙化、死亡风险和肠道微生物组之间的潜在联系,为该类患者的治疗防控提供参考。方法 选取本院符合纳入标准的慢性肾脏病患者45例作为研究对象,其中24例进行血液透析的患者为透析组,21例未进行血液透析的患者为未透析组。应用16SrDNA测序技术检测患者肠道菌群,并使用生物信息学方法分析各组对象肠道菌群变化。结果 透析组发生血管钙化12例,死亡1例;未透析组发生血管钙化5例,死亡0例;透析组血管钙化率及死亡率均高于未透析组,但差异无统计学意义(P>0.05)。2组厚壁菌门、拟杆菌门、变形菌门和放线菌门丰度较高,透析组患者拟杆菌门的丰度低于未透析组(P<0.05),放线菌门的丰度高于未透析组,差异有统计学意义(P<0.05)。两组肠道菌群有离散趋势,说明两组肠道菌群组成存在差异。2组Shannon指数和Chaol指数比较,差异无统计学意义(P>0.05)。2组比较有16个差异菌,透析组患者中肠杆菌目、放线菌门、埃希菌?志贺菌属等的丰度升高,未透析组的拟杆菌门、毛螺菌属丰度升高。结论 慢性肾脏病血液透析患者血管钙化、死亡风险和肠道微生物组密切相关,互相影响。透析组的肠道菌群中潜在病原体显著增加,有益细菌显著减少,血液钙化及死亡风险高于未透析组。

Objective To preliminarily analyze the potential relationship between vascular calcification,death risk and intestinal microbiota in hemodialysis patients with chronic kidney disease(CKD),and to provide reference for the treatment and prevention of this kind of patients.Methods Forty-five patients with chronic kidney disease who met the inclusion criteria in our hospital were selected as the research object,of which 24 patients with hemodialysis were dialysis group and 21 patients without hemodialysis were non-dialysis group.The intestinal flora of patients was detected by 16SrDNA sequencing technology,and the changes of intestinal flora in each group were analyzed by bioinformatics method.Results There were 12 cases of vascular calcification and 1 case of death in the dialysis group;There were 5 cases of vascular calcification and 0 deaths in the non dialysis group;The vascular calcification rate and mortality rate in the dialysis group were higher than those in the non dialysis group,but the difference was not statistically significant(P>0.05).The abundance of Firmicutes,Bacteroidetes,Proteobacteria,and Actinobacteria was higher in two groups.The abundance of Bacteroidetes in the dialysis group was lower than that in the non dialysis group(P<0.05),while the abundance of Actinobacteria was higher than that in the non dialysis group(P<0.05),and the difference was statistically significant.The two groups of gut microbiota showed a trend of dispersion,indicating differences in the composition of the two groups of gut microbiota.There was no statistically significant difference(P>0.05)between the two groups of Shannon index and Chaol index.There are 16 different bacteria compared between the two groups.The abundance of Enterobacteriales,Actinobacteria,Escherichia coli,and Shigella increased in the dialysis group,while the abundance of Bacteroidetes and Spirulina increased in the non dialysis group.Conclusion The potential pathogens in intestinal flora in dialysis group increased significantly,while the beneficial bacteria decreased significantly,and the risk of blood calcification and death was higher than that in non-dialysis group.