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重症急性胰腺炎肠道菌群特征及早期肠内营养联合微生态制剂治疗的临床价值

Analysis of gut microbiota characteristics in severe acute pancreatitis and evaluation of clinical value of early enteral nutrition combined with probiotics treatment
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摘要 目的分析重症急性胰腺炎(SAP)肠道菌群特征,探讨早期肠内营养联合应用微生态制剂的临床价值。方法选择前瞻性队列研究方式,选取2021年1月至2022年12月在沧州市人民医院治疗的SAP患者80例作为观察组,按照随机数字表法分为观察A组(40例)和观察B组(40例),选择同期体检健康人群的20例为对照组,以16S rDNA V3-V4区段实施PCR扩增,采取Illumina Miseq高通量测序平台评价肠道菌群特征。观察A组给予早期肠内营养,观察B组给予早期肠内营养联合应用微生态制剂治疗,评价治疗后的临床疗效,对比治疗前后的腹内压、胃肠功能、血清炎症因子以及血清脂肪酶、淀粉酶等指标。结果α多样性分析结果提示:观察组在Shannon指数上明显低于对照组(P<0.05),在Chao指数方面差异则无统计学意义(P>0.05)。在肠道菌群门水平上,观察组在变形菌门相对丰度较高,厚壁菌门相对丰度明显较低;在属水平上,观察组在大肠志贺菌属和类杆菌相对丰度较高,布劳特菌属、双歧杆菌属及链球菌相对丰度较低。观察B组临床疗效好于观察A组(P<0.05)。治疗7 d、14 d,观察B组淀粉酶、脂肪酶、乳酸脱氢酶、白介素-6、肿瘤坏死因子-α、降钙素原、腹内压、胃肠功能评分均明显低于观察A组(P<0.05)。结论在SAP患者肠道菌群中致病性菌群多样性和丰度增加、有益菌多样性和丰度减少。早期肠内营养联合微生态制剂应用于SAP治疗能够提高疗效,促进血清指标恢复。 Objective To analyze the characteristics of gut microbiota in severe acute pancreatitis(SAP)and explore the clinical value of early enteral nutrition combined with probiotics treatment.Methods A prospective cohort study was used to select 80 patients with SAP who were treated in Cangzhou People's Hospital from January 2021 to December 2022 as the observation group.They were randomly divided into observation group A(40 cases)and observation group B(40 cases)using a random number table method.Twenty healthy individuals who underwent physical examination at the same time were selected as the control group.16S rDNA V3-V4 segments were selected for PCR amplification,and the Illumina Miseq high-throughput sequencing platform was applied to analyze the characteristics of gut microbiota.Observation group A received early enteral nutrition,and observation group B received early enteral nutrition combined with probiotics for treatment.The clinical efficacy after treatment was evaluated,and the abdominal pressure,gastrointestinal function,serum inflammatory factors,serum lipase,amylase,and other indicators before and after treatment were compared.Results Theα-diversity analysis results indicated that the Shannon index of the observation group was significantly lower than that of the control group(P<0.05).There was no statistically significant difference in the Chao index(P>0.05).At the level of gut microbiota,the observation group showed higher relative abundance in Proteobacteria and significantly lower relative abundance in Firmicutes.At the genus level,the observation group had a higher relative abundance of Escherichia coli and Bacteroids.The relative abundance of Brucella,Bifidobacterium,and Streptococcus was relatively low.The clinical efficacy of observation group B was better than that of observation group A(P<0.05).The amylase,lipase,lactate dehydrogenase,interleukin-6,tumor necrosis factor-α,procalcitonin,abdominal pressure,gastrointestinal function score in observation group B was significantly lower than those in observation group A after 7 days and 14 days of treatment(P<0.05).Conclusion The diversity and abundance of pathogenic bacteria in the gut microbiota of patients with SAP increase,while the diversity and abundance of beneficial bacteria decrease.Early enteral nutrition combined with probiotics improves the treatment effect of SAP and promotes the recovery of serum indicators.
作者 宋燕秋 戚桂艳 杨双双 周萍 Song Yanqiu;Qi Guiyan;Yang Shuangshuang;Zhou Ping(Department of Critical Care Medicine,Cangzhou People's Hospital,Cangzhou 061000,China)
出处 《中华消化病与影像杂志(电子版)》 2024年第5期442-447,共6页 Chinese Journal of Digestion and Medical Imageology(Electronic Edition)
关键词 重症急性胰腺炎 肠道菌群 早期肠内营养 微生态制剂 Severe acute pancreatitis Intestinal microbiota Early enteral nutrition Microecological preparations
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