基于宏基因组学研究早期肠内营养联合微生态制剂对急性胰腺炎患儿肠道菌群的影响

The impact of early enteral nutrition in combination with microecological preparation on the intestinal flora of children with acute pancreatitis was investigated using metagenomics analysis

目的基于宏基因组学研究早期肠内营养联合微生态制剂对急性胰腺炎患儿肠道菌群的影响。方法选取2021年1月至2023年12月期间苏州大学附属儿童医院收治的156例急性胰腺炎患儿作为研究对象。采用随机数字法将患者随机分为联合组(n=78)和对照组(n=78)。两组均进行常规治疗,对照组进行早期肠内营养支持,联合组在对照组的基础上加用微生态制剂治疗。比较两组患者的临床资料,收集患者肠道粪便标本进行宏基因组检测,并进行生物信息学分析,比较两组患者肠道菌群的变化。结果在治疗前,两组患者在临床资料、α多样性和β多样性、肠道菌群数量、物种组成与相对丰度等方面均未见显著差异(P>0.05)。在接受治疗后,两组患者在白细胞计数(WBC)、白蛋白(ALB)、脂肪酶(LIP)、淀粉酶(AMY)、C反应蛋白(CRP)、降钙素原(PCT)、α多样性、β多样性、肠道菌群数量、物种组成与相对丰度等方面均具有显著的统计学差异(P<0.05)。利用Lefse法分析两组患者肠道优势菌属,结果表明,治疗前对照组和联合组的差异性优势菌属为拟杆菌属(Bacteroides)和大肠埃希菌属(Escherichia)。治疗后,Bacteroides、乳酸杆菌属(Lactobacillus)、Prevotella为对照组的差异性优势菌属;Bacteroides、Lactobacillus、Prevotella和双歧杆菌属(Bifidobacterium)为联合组的差异性优势菌属。KEGG功能富集分析的结果显示,治疗前,两组患者在各功能类别的基因表达无显著差异;经治疗后,对照组和联合组之间的差异基因显著富集在糖代谢、氨基酸代谢、碳水化合物代谢、脂代谢以及信号转导等关键通路上。结论早期肠内营养与微生态制剂的结合应用,对于急性胰腺炎患儿改善其肠道菌群具有显著效果。

Objective The impact of early enteral nutrition in combination with microecological preparation on the intestinal flora of children with acute pancreatitis was investigated using metagenomics.Methods A total of 156 pediatric patients diagnosed with acute pancreatitis and admitted to Children’s Hospital of Soochow University between January 2021 and December 2023 were enrolled in this study.They were randomly assigned to either the combination group(n=78)or the control group(n=78)using a random number method.Both groups received standard treatment,while the control group also received early enteral nutrition support,and the combination group was additionally administered microecological preparations.Clinical data from both groups were compared,intestinal stool samples were collected for metagenomic detection,and biological information analysis was conducted to compare changes in the intestinal flora of patients in both groups.Results After the initiation of treatment,there were no significant differences in clinical data,αdiversity and β diversity,intestinal flora number,species composition and relative abundance between the two groups(P>0.05).Following treatment,statistically significant differences were observed in WBC,ALB,LIP,AMY,CRP,PCT,αdiversity,βdiversity,intestinal flora number,species composition and relative abundance between the two groups(P<0.05).The Lefse method was employed to analyze the dominant intestinal bacteria of both groups.The findings revealed that prior to treatment Bacteroides and Escherichia were the dominant bacteria in both the control group and combination group.Post-treatment analysis showed that Bacteroides,Lactobacillus,and Prevotella became dominant species in the control group while Bacteroides,Lactobacillus,Prevotella,and Bifidobacterium emerged as dominant genera in the combination group.KEGG functional enrichment analysis indicated no significant differences in gene expression across all functional categories between the two groups before treatment;however post-treatment differential genes between control group and combination group were significantly enriched in key pathways including glucose metabolism amino acid metabolism carbohydrate metabolism lipid metabolism and signal transduction.Conclusion The combination of early enteral nutrition and microecological preparations has a remarkable effect on improving the intestinal flora of children with acute pancreatitis.