肠道菌群多样性及其代谢产物与慢性心力衰竭患者心功能的相关性分析

Correlation Analysis of Intestinal Flora Diversity and Its Metabolites with Cardiac Function in Patients with Chronic Heart Failure

目的探究肠道菌群多样性及其代谢产物与慢性心力衰竭(CHF)患者心功能的相关性。方法将2020年5月—2022年5月新疆医科大学第五附属医院收治的CHF患者50例作为CHF组,另选取同期该院收治的非CHF患者50例作为对照组。比较两组肠道菌群α多样性指标(Chao指数、Ace指数、Shannon指数、Simpson指数)、肠道菌群β多样性、肠道菌群代谢产物[氧化三甲胺(TMAO)、胆汁酸(BA)、乙酸、丙酸、丁酸、异丁酸水平],记录CHF患者心功能指标[N末端脑钠肽前体(NT-proBNP)水平、左心室射血分数(LVEF)、6 min步行距离(6MWD)]。采用Pearson相关分析探讨CHF患者肠道菌群多样性指标及其代谢产物与心功能指标的相关性。结果CHF组Chao指数、Ace指数低于对照组(P<0.05)。主坐标分析(PCoA)结果显示,对照组与CHF组样本基本分别聚集在不同象限,且样本间多样性差异较大(32.91%比11.93%;R^(2)=0.276,P=0.026)。CHF组TMAO、BA水平高于对照组,乙酸、丙酸、丁酸、异丁酸水平低于对照组(P<0.05)。Pearson相关分析结果显示:CHF患者Chao指数、Ace指数分别与NT-proBNP水平呈负相关,分别与LVEF、6MWD呈正相关(P<0.05);CHF患者TMAO、BA水平分别与NT-proBNP水平呈正相关,分别与LVEF、6MWD呈负相关(P<0.05);CHF患者乙酸、丙酸、丁酸、异丁酸水平分别与NT-proBNP水平呈负相关,分别与LVEF、6MWD呈正相关(P<0.05)。结论CHF患者肠道菌群物种减少,多样性差异增大,肠道菌群代谢异常,且肠道菌群物种减少及其代谢产物异常均会加重患者心功能损伤。

Objective To analyze the correlation of intestinal flora diversity and its metabolites with cardiac function in patients with chronic heart failure(CHF).Methods Fifty patients with CHF who were hospitalized in the Fifth Affiliated Hospital of Xinjiang Medical University from May 2020 to May 2022 were enrolled as the CHF group.At the same time,50 patients without CHF were selected as the control group.αdiversity indexes of intestinal flora(Chao index,Ace index,Shannon index,Simpson index),βdiversity indexes of intestinal flora,metabolites of intestinal flora[levels of trimethylamine oxide(TMAO),bile acid(BA),acetic acid,propionic acid,butyric acid,isobutyric acid]were compared between the two groups,and cardiac function indexes[N-terminal pro-brain natriuretic peptide(NT-proBNP)level,left ventricular ejection fraction(LVEF),6-minute walking distance(6MWD)]of patients with CHF were recorded.Pearson correlation analysis was used to examine the correlation between intestinal flora diversity indexes and its metabolites and cardiac function indexes in patients with CHF.Results The Chao index and Ace index in the CHF group were lower than those in the control group(P<0.05).The principal co-ordinates analysis results showed that the samples of the control group and CHF group were basically clustered in different quadrants,and the diversity of the samples was significantly different(32.91%vs.11.93%;R^(2)=0.276,P=0.026).The levels of TMAO and BA in the CHF group were higher than those in the control group,while the levels of acetic acid,propionic acid,butyric acid,isobutyric acid were lower than those in the control group(P<0.05).Pearson correlation analysis results showed that:the Chao index and Ace index in CHF patients were negatively correlated with NT-proBNP level and positively correlated with LVEF and 6MWD,respectively(P<0.05).The levels of TMAO and BA in CHF patients were positively correlated with NT-proBNP level and negatively correlated with LVEF and 6MWD,respectively(P<0.05).Meanwhile,the levels of acetic acid,propionic acid,butyric acid,isobutyric acid were negatively correlated with NT-proBNP level and positively correlated with LVEF and 6MWD,respectively(P<0.05).Conclusion In CHF patients,the number of intestinal flora species decreased,the difference of diversity increased,the gut microbiota metabolism was abnormal,and the reduction of intestinal flora species and the abnormality of their metabolites can both aggravate the cardiac function injury of patients.