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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 442 -447. doi: 10.3877/cma.j.issn.2095-2015.2024.05.012

论著

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
宋燕秋1, 戚桂艳1,†(), 杨双双1, 周萍1   
  1. 1. 061000　河北省，沧州市人民医院重症医学科
  • 收稿日期:2023-12-09 出版日期:2024-10-01
  • 通信作者: 戚桂艳

Analysis of gut microbiota characteristics in severe acute pancreatitis and evaluation of clinical value of early enteral nutrition combined with probiotics treatment

Yanqiu Song1, Guiyan Qi1,†(), Shuangshuang Yang1, Ping Zhou1   

  1. 1. Department of Critical Care Medicine, Cangzhou People's Hospital, Cangzhou 061000, China
  • Received:2023-12-09 Published:2024-10-01
  • Corresponding author: Guiyan Qi
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引用本文：

宋燕秋, 戚桂艳, 杨双双, 周萍. 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[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 442-447.

Yanqiu Song, Guiyan Qi, Shuangshuang Yang, Ping Zhou. Analysis of gut microbiota characteristics in severe acute pancreatitis and evaluation of clinical value of early enteral nutrition combined with probiotics treatment[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 442-447.

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。

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
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

The α-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.

Key words: Severe acute pancreatitis, Intestinal microbiota, Early enteral nutrition, Microecological preparations
表1 各组临床情况比较
组别 例数 性别[例(%)] 年龄(岁,±s) 民族[例(%)]
男 女 汉族 其他
对照组 20 12(60.00) 8(40.00) 44.38±11.27 14(70.00) 6(30.00)
观察组 80 51(63.75) 29(36.25) 42.16±10.68 44(55.00) 36(45.00)
χ2/t值   0.097 0.822 1.478
P值   0.756 0.413 0.224
观察A组 40 27(67.50) 13(32.50) 41.77±10.81 24(60.00) 16(40.00)
观察B组 40 24(60.00) 16(40.00) 42.55±10.55 20(50.00) 20(50.00)
χ2/t值   0.487 0.327 0.808
P值   0.485 0.745 0.369
图1 观察组与对照组肠道菌群α多样性分析结果
图2 观察组与对照组肠道菌群差异分析
表2 各观察组临床疗效比较[例（%）]
组别 例数 痊愈 有效 无效 治疗有效率(%)
观察A组 40 28(70.00) 10(25.00) 2(5.00) 95.00
观察B组 40 19(47.50) 12(30.00) 9(22.50) 77.50
表3 各观察组不同时间腹内压比较（mmHg，±s）
组别 例数 腹内压 F值 P值
治疗前 治疗7 d 治疗14 d
观察A组 40 18.74±4.47 16.21±3.48 13.56±3.01 21.131 <0.001
观察B组 40 19.11±4.92 14.48±3.08 12.05±3.38 34.222 <0.001
t值   0.352 2.354 2.110    
P值   0.726 0.021 0.038    
表4 各观察组不同时间胃肠功能评分比较（±s）
组别 例数 胃肠功能评分 F值 P值
治疗前 治疗7 d 治疗14 d
观察A组 40 1.55±0.44 0.87±0.18 0.44±0.09 160.664 <0.001
观察B组 40 1.51±0.32 0.63±0.12 0.28±0.07 396.573 <0.001
t值   0.465 7.016 8.875    
P值   0.643 <0.001 <0.001    
表5 各观察组血清酶类水平比较（U/L，±s）
组别 例数 淀粉酶 脂肪酶 乳酸脱氢酶
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
观察A组 40 322.84±45.27 200.36±41.08 115.63±26.94 3638.84±746.73 1883.49±269.03 348.93±56.82 332.84±54.38 144.58±32.26 52.38±9.48
观察B组 40 330.57±37.29 178.38±43.49 77.32±17.36 3574.24±669.37 1648.37±228.82 226.84±45.48 328.61±44.80 122.84±27.31 33.75±7.74
t值   0.834 2.324 7.560 0.407 4.210 10.610 0.380 3.253 9.628
P值   0.407 0.023 <0.01 0.685 <0.01 <0.01 0.705 0.002 <0.01
表6 各观察组血清炎症因子水平比较（ng/mL，±s）
组别 例数 IL-6 TNF-α PCT
治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d 治疗前 治疗7 d 治疗14 d
观察A组 40 55.48±8.74 31.18±5.27 15.38±3.39 141.28±32.74 51.95±9.74 15.44±4.26 11.08±2.27 6.55±1.33 2.37±0.46
观察B组 40 56.38±9.37 27.36±4.59 11.48±2.84 137.46±26.09 36.48±8.82 23.74±5.48 10.21±1.89 5.12±1.18 1.68±0.33
t值   0.444 3.457 5.577 0.577 7.446 7.563 1.863 5.087 7.708
P值   0.658 0.001 <0.001 0.566 <0.001 <0.001 0.066 <0.001 <0.001
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