常见消化系统疾病湿热证微生态研究及思考

消化系统疾病湿热证是临床常见的疾病之一,消化道菌群的变化参与了慢性胃炎、溃疡性结肠炎、肠易激综合征及非酒精性脂肪肝等常见消化系统疾病湿热证的发生发展。正常生理状态下,消化道内的菌群相对处于微妙的平衡中,一旦被疾病“扰动”会发生一种特异性偏离状态,表现为中医不同“证候”,并通过不同部位菌群的多样性、丰度、结构等特征改变而客观地反映出来。本文就近20年来常见消化系统疾病菌群湿热证研究相关文献进行梳理,从同病同证和异病同证两个方面对文献中的差异菌群进行比较和分析,从门、属、科3个水平筛选出相同的肠道差异菌群,以期为临床上非侵入性湿热证诊断及疾病治疗方面提供新的切入点。

慢性萎缩性胃炎患者肠道菌群特征

目的探讨不同炎症程度慢性萎缩性胃炎(CAG)患者肠道菌群特征,为该类患者的治疗提供参考。方法对36例健康人(健康对照组)和8例轻度炎症(轻度炎症组)、26例中度炎症(中度炎症组)、8例重度炎症(重度炎症组)的CAG患者的粪便样本进行16S rRNA基因高通量测序(V4—V5区),采用Sobs、Shannon、Simpson、Ace、Chao指数评估4组对象肠道菌群的物种丰富度与多样性;采用PLS-DA分析评估4组对象肠道微生物群落结构;采用LDA与LEfSe分析确定4组对象相对丰度存在显著差异的肠道菌群;采用PICRUSt预测CAG患者显著富集肠道菌属的代谢通路信息。结果与健康对照组相比,轻、中、重度炎症组患者肠道菌群Sobs、Ace、Chao、Simpson指数有降低趋势,但差异均无统计学意义(均P>0.05)。Ruminococcus_gnavus_group、norank_f_Ruminococcaceae、Erysipelatoclostridium、Actinomyces在轻度炎症组中显著富集,Flavonifractor、Sellimonas在中度炎症组中显著富集,Eubacterium_rectale_group、Erysipelotrichaceae_UCG-003、Tyzzerella_3、Coprococcus_1、Candidatus_Soleaferrea在重度炎症组中显著富集。此外,Lachnospiraceae_UCG-004、Eubacterium_nodatum_group的丰度在健康对照组、轻度炎症组、中度炎症组、重度炎症组中呈递增趋势;Anaerostipes、Ruminiclostridium_9、Halomonas、Pelagibacterium的丰度在健康对照组、轻度炎症组、中度炎症组、重度炎症组中呈递减趋势,但差异均无统计学意义(均P>0.05)。PICRUSt分析结果显示4组对象肠道菌群代谢通路相似,但是代谢通路的丰度不同,其中重度炎症组患者肠道菌群代谢功能潜力高于健康对照组、轻度炎症组和中度炎症组。结论CAG患者肠道菌群变化的总体特征为产丁酸盐的菌属丰度减少,促炎菌属的丰度增加。促炎菌属可能通过附着于肠道上皮导致黏膜屏障受损和肠道通透性增加,影响宿主免疫反应,引起炎症。

Study on tongue coating microbes of bitter taste,sticky and greasy taste in chronic atrophic gastritis

OBJECTIVE:To objectively reveal the relationship between tongue coating microbes and bitter taste,sticky and greasy taste in chronic atrophic gastritis(CAG)patients.METHODS:16S rRNA high-throughput sequencing was used to detect bacterial diversity and community composition of tongue coating microbes from samples of CAG patients.LEfSe algorithm was used for discovering the different tongue coating microbes in CAG patients with or without bitter taste,also that in CAG patients with or without sticky and greasy taste.RESULTS:We respectively compared the features of tongue coating microbes in bitter taste,sticky and greasy taste of CAG patients.At the genus level,25 tongue coating microbes were significantly different in CAG patients with bitter taste or without bitter taste;17 tongue coating microbes were significantly different in CAG patients with sticky and greasy taste or without sticky and greasy taste.Campylobacter and Rothia were closely related to CAG patients with bitter taste.Enterococcus,Serratia,Leptotrichia and Selenomonas were closely related to CAG patients with stick and greasy taste.CONCLUSION:Campylobacter and Rothia possibly contribute to bitter taste of CAG patients,and Enterococcus,Serratia,Leptotrichia and Selenomonas contribute to stick and greasy taste of CAG patients,which is potential for the diagnosis and treatment of CAG.