成人脓毒症与肠道菌群失衡的相关性研究

陈兰涛 李晓娜 谢杰 田丹丹 刘单霞 段宝民

【摘要】 目的  分析成人脓毒症与肠道菌群失衡的相关性。

方法  选择2017年1月至2019年12月期间75例脓毒症患者及同期24名健康体检者为研究对象，分别设为患者组、健康组，其中患者组依据其病情严重程度分为脓毒症组45例、脓毒症休克组30例，均实施粪便菌群检测，评价成人脓毒症与肠道菌群的相关性。

结果  患者组肠道菌群失衡[B/E（双歧杆菌/肠杆菌）]<1）占比为80.00%，较健康组（25.00%）高（ P <0.01）;患者组中脓毒症组、脓毒症休克组肠道菌群失衡占比分别为73.33%、90.00%，;健康组、脓毒症组、脓毒症休克组B/E值比较，差异有统计学意义（ P <0.001），脓毒症休克组B/E值低于脓毒症组（ P <0.05）;脓毒症患者病情严重程度与B/E比值水平呈负相关（Kendalls tau-b= -0.439， P <0.001）。

结论  成人脓毒症严重程度与肠道菌群失衡呈现相关性。

【关键词】  肠道菌群失衡;成人脓毒症;内毒素

中图分类号： R459.7    文献标志码： A    DOI： 10.3969/j.issn.1003-1383.2021.08.005

Study on correlation between sepsis and imbalance of intestinal flora in adults

CHEN Lantao， LI Xiaona， XIE Jie， TIAN Dandan， LIU Danxia， DUAN Baomin▲

（Emergency Center， Kaifeng Central Hospital， Kaifeng 475000， Henan， China）

【Abstract】 Objective  To analyze correlation between sepsis and the imbalance of  intestinal flora in adults.

Methods  75 patients with sepsis from January 2017 to December 2019 and 24 healthy people who underwent physical examination during the same period were selected for the study. They were divided into patient group and healthy group， among which the patient group were divided into sepsis group （ n  = 45） and sepsis shock group （ n  = 30） according to the severity of the disease， and all of which were given fecal flora testing to evaluate the correlation between sepsis and intestinal flora in adults.

Results  The percentage of intestinal flora imbalance （bifidobacterium/enterobacteriaceae [B/E] < 1） in the patient group was 80.00%， which was higher than that in the healthy group （25.00% ） （ P  < 0.01）; the percentage of intestinal flora imbalance in the sepsis group and the sepsis shock group was 73.33% and 90.00%， respectively （ P  < 0.05）; the difference of the B/E ratio of the healthy group， the sepsis group and the sepsis shock group was statistically significant （ P  < 0.001）， and that of the sepsis shock group was lower than that of the sepsis group （ P  < 0.05）; the severity of sepsis patients was negatively correlated with the level of B/E ratio （Kendalls tau-b = -0.439，  P  < 0.001）.

Conclusion  The severity of sepsis in adults is correlated with the imbalance of intestinal flora.

【Key words】  imbalance of intestinal flora; adult sepsis; endotoxin

膿毒症指病原微生物侵入组织器官及血液循环诱发的全身性炎性反应，随着感染症状加重，可逐渐出现多器官功能障碍、休克等症状，严重威胁患者生命安全[1]。人的胃肠道大约有1000多种不同种类的细菌[2]，包括专性厌氧菌（95%）和兼性厌氧菌（5%），专性厌氧菌包括双歧杆菌、梭状芽孢杆菌等，双歧杆菌是80%的婴儿和25%的成年人中可培养的主要微生物，这些微生物在肠道特定区域内，直接激活肠上皮的发育和分化，并维持肠上皮细胞的完整性[3]，是保证肠道生理机能及免疫功能的重要屏障，其多种疾病状态下都会发生较大改变[4]，甚至当机体出现应激反应时，肠道菌群微生态平衡都会遭到破坏，表现出胃肠道症状[5]。相关研究认为[6～7]，发生脓毒症后患者肠道菌群平衡性会出现明显变化，肠道屏障能力丧失，可影响患者肠道营养吸收能力，进而影响其免疫功能恢复[8]。……