治疗前肠道菌群多样性与肠易激综合征患者益生菌治疗效果的相关性

Correlation between intestinal flora diversity before treatment and the efficacy of probiotics in patients with irritable bowel syndrome

目的 分析肠易激综合征(irritable bowel syndrome, IBS)患者经过益生菌治疗后的肠道菌群变化及疗效评分,探讨治疗前IBS患者肠道菌群特征与益生菌治疗效果的相关性。方法 纳入2021年3月至2022年3月在新疆军区总医院接受治疗的腹泻型肠易激惹综合征(diarrhea predominant irritable bowel syndrome, IBS-D)患者50例。在常规治疗基础上给予益生菌(双歧杆菌乳酸杆菌三联活菌片)治疗4周;收集患者治疗前后粪便样本,采用16S rDNA测序,分析治疗前后肠道菌群整体结构及多样性特征,比较显著差异物种;比较治疗前后IBS生活质量(IBS-quality of life, IBS-QOL)、IBS病情严重程度(IBS symptom severity scale, IBS-SSS)、胃肠道症状评分(gastrointestinal symptoms rating scales, GSRS)、粪便分型量表(Bristol stool form scale, BSFS)评分变化;采用Pearson相关性分析IBS患者肠道菌群水平与各量表评分的相关性。结果 肠道菌群α多样性方面,治疗前Chao指数、Ace指数低于治疗后,差异有统计学意义(P<0.05);治疗前后肠道菌群β多样性差异有统计学意义(P<0.05);治疗前患者肠道菌群中以肠杆菌属(Enterobacteriaceae)、链球菌属(Streptococcus)、乳杆菌属(Lactobacillus)等占主要优势;治疗后以拟杆菌门(Bacteroidetes)、双歧杆菌属(Bifidobacterium)等占主要优势;临床疗效方面,治疗后IBS-QOL评分高于治疗前,IBS-SSS评分、GSRS评分、BSFS评分低于治疗前,差异有统计学意义(P<0.05);Pearson相关性分析显示,梭菌、放线菌、链球菌、粪杆菌、乳杆菌水平与IBS-QOL评分呈负相关,与IBS-SSS评分、GSRS评分、BSFS评分呈正相关(P<0.05)。结论 早期应用益生菌能够有效改善IBS患者临床症状和肠道菌群失调,而IBS患者肠道内的菌群水平与益生菌治疗效果存在一定相关性。

Objective To analyze the changes in gut microbiota and efficacy scores in patients with irritable bowel syndrome(IBS)after probiotic treatment,and to explore the correlation between the gut microbiota characteristics of IBS patients before treatment and the effectiveness of probiotic therapy.Methods A total of 50 patients with diarrhea-predominant irritable bowel syndrome(IBS-D)treated at the Xinjiang Military Region General Hospital from Mar 2021 to Mar 2022 were included.Probiotics(Bifidobacterium and Lactobacillus triple viable tablets)were administered for 4 weeks on the basis of routine treatment.Fecal samples were collected before and after treatment,and the overall structure and diversity characteristics of the gut microbiota were analyzed using 16S rDNA sequencing,comparing significantly different species.Changes in IBS quality of life(IBS-QOL),IBS symptom severity scale(IBS-SSS),gastrointestinal symptoms rating scales(GSRS),and fecal type scale(Bristol stool form scale,BSFS)scores before and after treatment were compared.Pearson correlation analysis was used to analyze the correlation between the levels of gut microbiota in IBS patients and the scores of various scales.Results In terms of gut microbiotaα-diversity,the Chao and Ace indices before treatment were lower than after treatment,with statistically significant differences(P<0.05).There were obvious statistical differences in theβ-diversity of the gut microbiota before and after treatment(P<0.05).Before treatment,Enterobacteriaceae,Streptococcus and Lactobacillus were dominant in the intestinal flora of patients;Bacteroidetes and Bifidobacterium were dominant after treatment.In terms of clinical efficacy,the IBS-QOL score after treatment in the experimental group was higher than before treatment,while the IBS-SSS score,GSRS score and BSFS score were lower than before treatment,with statistically significant differences(P<0.05).Pearson correlation analysis showed that the levels of Clostridium,Actinobacteria,Streptococcus,Fecal bacilli,and Lactobacillus were negatively correlated with IBS-QOL scores,but positively correlated with IBS-SSS scores,GSRS scores and BSFS scores(P<0.05).Conclusion Early application of probiotics can effectively improve the clinical symptoms of IBS patients,and there is a certain correlation between the level of gut microbiota in IBS patients and the effectiveness of probiotic therapy.