急性颅脑外伤患者肠道菌群多样性差异对继发性全身炎症反应综合征的临床预测价值

The clinical predictive value of differences in gut microbiota diversity for secondary systemic inflammatory response syndrome in patients with acute traumatic brain injury

目的探讨急性颅脑外伤患者肠道菌群多样性差异对继发性全身炎症反应综合征(SIRS)的临床预测价值。方法回顾性分析2022年1月—2023年12月固原市人民医院急诊重症监护病房和神经外科重症监护病房收治的急性颅脑外伤患者60例。按SIRS诊断标准分为单纯急性颅脑外伤组(非SIRS组)与急性颅脑外伤后继发性SIRS组(SIRS组);收集患者一般资料并进行临床指标检测,通过16S rRNA基因测序比较两组肠道菌群多样性与菌属相对丰度,采用Pearson相关性分析肠道菌群与临床指标的关系,采用受试者工作特征(ROC)曲线分析肠道菌群对SIRS的预测价值。结果两组患者性别构成、年龄、红细胞计数、血小板计数比较,差异均无统计学意义(P>0.05)。SIRS组体温较非SIRS组高、心率较非SIRS组快、白细胞计数较非SIRS组多、C反应蛋白水平较非SIRS组高(P<0.05)。两组患者Chao1和Shannon指数比较,差异均无统计学意义(P>0.05)。两组患者拟杆菌属、瘤胃球菌属、阿克曼菌属、粪肠球菌属相对丰度比较,差异均无统计学意义(P>0.05)。SIRS组普雷沃菌属相对丰度低于非SIRS组(P<0.05),埃希菌-志贺菌属、棒状杆菌属相对丰度均高于非SIRS组(P<0.05)。Pearson相关性分析结果表明,体温、心率、白细胞计数及C反应蛋白与普雷沃菌属相对丰度均呈负相关(r=-0.574、-0.539、-0.554和-0.572,均P<0.05);体温、心率、白细胞计数及C反应蛋白与埃希菌-志贺菌属相对丰度呈正相关(r=0.751、0.743、0.657和0.770,均P<0.05),与棒状杆菌属相对丰度均呈正相关(r=0.782、0.762、0.707和0.799,均P<0.05)。ROC曲线分析结果表明,联合诊断的预测效能最高,曲线下面积为0.946(95%CI:0.871,1.000),敏感性为96.7%(95%CI:0.902,0.100),特异性为93.3%(95%CI:0.844,0.100)。结论肠道菌群组成的变化与颅脑损伤后SIRS的发展密切相关,特定菌属的丰度变化可作为SIRS发展的早期生物预警信号。

Objective To explore the clinical predictive value of differences in gut microbiota diversity for secondary systemic inflammatory response syndrome(SIRS)in patients with acute traumatic brain injury.Methods A retrospective analysis was conducted on 60 patients with acute traumatic brain injury treated in the Emergency Intensive Care Unit(ICU)and Neurosurgical ICU of Guyuan People's Hospital from January 2022 to December 2023.Patients were divided into the simple acute traumatic brain injury group(non-SIRS group)and the posttraumatic SIRS group(SIRS group)based on the diagnostic criteria of SIRS.The general data of patients were collected and clinical indicators were detected.The gut microbiota diversity and the genus-level relative abundance were compared between the two groups using 16S rRNA gene sequencing.Pearson correlation analysis was performed to assess the relationships between gut microbiota and clinical indicators,and the diagnostic value of the gut microbiota for SIRS was evaluated using the receiver operating characteristic(ROC)curve.Results There was no statistically significant difference between the two groups of patients in terms of sex composition,age,red blood cell count,and platelet count(P>0.05).Compared to the non-SIRS group,the SIRS group had higher body temperature,faster heart rates,higher white blood cell count,and elevated C-reactive protein levels(P<0.05).There was no statistically significant difference in Chao1 and Shannon indices between the two groups(P>0.05).The comparison of the relative abundances of Bacteroides,Ruminococcus,Akkermansia,and Enterococcus between the two groups showed no statistically significant differences as determined by the t-test(P>0.05).The relative abundance of Prevotella was lower in the SIRS group compared with that in the non-SIRS group(P<0.05),and the relative abundances of Escherichia-Shigella and Corynebacterium were higher in the SIRS group than in the non-SIRS group(P<0.05).Pearson correlation analysis indicated that body temperature,heart rate,white blood cell count,and C-reactive protein levels were negatively correlated with the relative abundance of Prevotella(r=-0.574,-0.539,-0.554 and-0.572,all P<0.05),and positively correlated with the relative abundances of Escherichia-Shigella(r=0.751,0.743,0.657 and 0.770,all P<0.05)and Corynebacterium(r=0.782,0.762,0.707 and 0.799,all P<0.05).The ROC curve analysis revealed that the combined detection yielded the highest predictive efficacy,with an AUC of 0.946(95%CI:0.871,1.000),a sensitivity of 96.7%(95%CI:0.902,0.100),and a specificity of 93.3%(95%CI:0.844,0.100).Conclusions Changes in the composition of the gut microbiota are closely related to the development of SIRS following traumatic brain injury,and changes in the abundance of specific bacterial genera can serve as early biomarkers for the development of SIRS.