糖尿病肾病患者肠道菌群生态特点与胃肠道功能障碍的关联性研究

Correlation between ecological characteristics of intestinal flora and gastrointestinal dysfunction in patients with diabetic nephropathy

目的分析糖尿病肾病(DKD)患者肠道菌群生态特点,并探究肠道菌群生态特点与患者胃肠道功能障碍的关联性。方法选取无锡市锡山人民医院2021年3月至2023年3月收治的150例DKD患者,纳入DKD组,并选取同期2型糖尿病(T2DM)患者80例,纳入T2DM组。采集患者新鲜粪便样本,行16sRNA检测,比较2组肠道菌群组成、丰度和多样性差异。按照DKD组患者胃肠道功能障碍症状是否存在,将其分别纳入有功能障碍组、无功能障碍组,对比2亚组患者肠道菌群特点,分析DKD及胃肠道功能障碍与肠道菌群生态特点的关联。结果α多样性分析提示,DKD组Chao指数明显高于T2DM组,Shannon指数明显低于T2DM组,差异均有统计学意义(P<0.05)。β多样性主成分分析提示,DKD组、T2DM组肠道菌群结构存在差异性(P<0.05)。门水平上,DKD组厚壁菌门相对丰度较低,变形菌门相对丰度较高;在属水平上,DKD组在大肠志贺菌属相对丰度增加,布劳特菌属、拟杆菌相对丰度降低。150例DKD患者中,103例(68.67%)合并胃肠道功能障碍症状。在厚壁菌门相对丰度水平方面比较,有功能障碍组低于T2DM组和无功能障碍组。在变形菌门相对丰度水平方面,有功能障碍组高于T2DM组和无功能障碍组(P<0.01)。有功能障碍组在厚壁菌门与超敏C反应蛋白、白介素-6呈现正相关,而变形菌门与超敏C反应蛋白、白介素-6呈现负相关(P<0.05)。结论DKD患者致病性菌群多样性和丰度增加、有益菌多样性和丰度减少。DKD患者发生胃肠道功能障碍可能与厚壁菌门相对丰度降低,变形菌门相对丰度升高有关。

Objective To analyze the ecological characteristics of intestinal flora in patients with diabetes nephropathy(DKD),and explore the correlation between the ecological characteristics of intestinal flora and gastrointestinal dysfunction.Methods A total of 150 patients with DKD admitted to Wuxi Xishan People's Hospital from March 2021 to March 2023 were selected and included in the DKD group,and 80 patients with type 2 diabetes mellitus(T2DM)were selected and included in the T2DM group.Fresh fecal samples were collected from patients,16sRNA detection was performed,and the differences in gut microbiota composition,abundance,and diversity were compared between the two groups.According to the presence or absence of gastrointestinal dysfunction symptoms in DKD group patients,they were separately included in the functional impairment group and the non impairment functional group.The characteristics of gut microbiota in the two subgroups were compared,and the association between DKD and gastrointestinal dysfunction and the ecological characteristics of gut microbiota was analyzed.Results Theαdiversity analysis results indicated that the Chao index of the DKD group was significantly higher than that of the T2DM group,and the Shannon index was significantly lower than that of the T2DM group,with statistically significant difference(P<0.05).Theβdiversity principal component analysis showed that there were differences in the gut microbiota structure between the DKD group and the T2DM group(P<0.05).At the phylum level,the relative abundance of Firmicutes in the DKD group was lower,while the relative abundance of Proteobacteria was higher.At the genus level,the relative abundance of Escherichia Shigella in the DKD group increased,while the relative abundance of Blautia and Bacteroides decreased.Among 150 DKD patients,103(68.67%)had gastrointestinal dysfunction symptoms.In terms of relative abundance levels of Firmicutes,the functional impairment group was lower than the T2DM group and the non functional impairment group.In terms of the relative abundance level of Proteobacteria,the functional impairment group was higher than the T2DM group and the non functional impairment group,with statistically significant differences(P<0.01).Firmicutes in the functional impairment group was positive correlated with hypersensitive C-reactive protein and interleukin-6,while Proteobacteria was negatively correlated with hypersensitive C-reactive protein and interleukin-6(P<0.05).Conclusion The diversity and abundance of pathogenic bacteria in patients with diabetes nephropathy are increased,while the diversity and abundance of beneficial bacteria are decreased.Gastrointestinal dysfunction in patients with diabetes nephropathy may be related to the decrease of the relative abundance of Firmicutes and the increase of the relative abundance of Proteobacteria.