老年慢性阻塞性肺病合并冠状动脉疾病的微生态变化分析

Analysis of microbiota changes in elderly with chronic obstructive pulmonary disease combined with coronary artery disease

目的分析老年慢性阻塞性肺病(COPD)合并冠状动脉疾病(CAD)患者肺部及肠道微生态的变化,并探讨其免疫调控机制。方法选择2022年1—6月四川省医学科学院·四川省人民医院(电子科技大学附属医院)老年医学科收治的COPD老年患者为研究对象,其中,COPD组患者20例和COPD合并CAD组患者20例,并选取同期健康老年人群15例作为对照组,检测肺部和肠道样本菌群及外周血炎症因子。结果各组样本间细菌多样性指数比较差异无统计学意义(P>0.05)。在门水平上,COPD合并CAD组与对照组相比,肺部和肠道菌群中厚壁菌门减少,变形菌门、放线菌门均增多(P<0.05);与COPD组相比,肠道菌群中厚壁菌门减少,放线菌门增多(P<0.05)。在属水平上,COPD合并CAD组的肺部菌群中假单胞菌属增多,链球菌属、韦荣氏菌属、普雷沃氏菌属、放线菌属减少(P<0.05);肠道菌群中埃希氏菌属增多,拟杆菌属、肠球菌属、乳杆菌属减少(P<0.05)。在细胞因子表达水平上,COPD合并CAD组的白细胞介素(IL)-2、IL-4、IL-6、肿瘤坏死因子(TNF)-α升高,IL-10降低(P<0.05)。结论COPD合并CAD患者的肺部及肠道微生物菌群数量和构成存在显著差异,表明肺部和肠道微生态失衡及全身炎症反应可能增加COPD患者罹患CAD风险。调节微生物群组成或其代谢物的途径,可能是老年慢性共病的潜在治疗策略。

Objective To analyze the changes in pulmonary and intestinal microecology in elderly patients with chronic obstructive pulmonary disease(COPD)and coronary artery disease(CAD),as well as to investigate the immune regulatory mechanisms.Method 20 COPD patients,20 COPD patients with CAD,and 15 healthy elderly individuals were recruited from the Department of Geriatrics at a tertiary hospital in Sichuan Province between January 2022 and June 2022.Pulmonary and intestinal samples from the subjects were analyzed for microbial diversity,while cytokine levels in peripheral blood specimens were measured.Result There was no significant difference observed in the bacterial diversity index among the the groups.In the phylum level,compared with the control group,Firmicutes decreased while Proteobacteria and Actinobacteria increased within both pulmonary and intestinal microecologies of COPDCAD group(P<0.05).Compared with the COPD group,the intestinal microbiota of the COPD-CAD group were more Actinobacteria and less Proteobacteria(P<0.05).In the genus level,the Pseudomonas increased while Streptococcus,Veillonella,Prevotella,Actinomyces decreased in the pulmonary microbiota of COPD-CAD group;the Escherichia increased while Bacteroides,Enterococcus,Lactobacillus decreased in the intestinal microbiota(P<0.05).In terms of cytokine expression levels for COPD-CAD group,there was an increase observed for interleukin(IL)-2,IL-4,IL-6,and tumor necrosis factor(TNF)-a but a decrease for IL-10(P<0.05).Conclusion Significant differences existed in both quantity and composition of lung and intestinal microbial flora among COPD patients with CAD,suggesting that microecology imbalances may contribute to systemic inflammatory responses increasing risk of COPD patients developing CAD.Modulating microbial community composition or its metabolites could be a potential therapeutic strategy for elderly individuals dealing with chronic comorbidities.