结肠癌患者舌苔类型与肠道菌群相关性研究

辛红 脱璐尧 初旭 徐巍

摘要 目的：本研究旨在探讨结肠癌患者常见舌苔类型与肠道菌群的相关性。方法：选取2019年3月至2019年9月哈尔滨医科大学附属第一医院收治的4种常见舌苔类型的结肠癌患者78例作为研究对象，采用高通量16S rDNA测序方法分析各组患者菌群的生物多样性及物种组成。结果：患者中薄白苔18例、薄黄苔12例、白腻苔22例、黄腻苔26例。4种舌苔类型结肠癌患者肠道菌群多样性差异有统计学意义（均P<0.05）。在门分类水平上，各组丰度最高的5个菌门为厚壁菌门（Fimicutes）、变形菌门（Proteobacteria）、拟杆菌门（Bacteroidetes）、放线菌门（Actinobacteria）、疣微菌门（Verrucomicrobia）。属分类水平上，各組排前10名的菌属丰度主要集中在肠球菌属（Enterococcus）、大肠埃希菌/志贺菌属（Escherichia/Shigella）、链球菌属（Streptococcus）、克雷伯氏菌属（Klebsiella）、阿克曼氏菌属（Akkermansia）、毛螺菌属（Lachnospiracea-incertae-sedis）、布劳特氏菌属（Blautia）、拟杆菌属（Bacteroides）、丹毒丝菌科未命名属（Erysipelotrichaceae-incertae-sedis）、双歧杆菌属（Bifidobacterium）。结论：结肠癌患者不同舌苔类型的肠道菌群在生物多样性与物种组成方面均具有显著的差异性，为进一步研究以舌象变化为主要辨证依据的结肠癌诊疗提供实验依据。

关键词 结肠癌;舌苔类型;肠道菌群;相关性;16S rDNA;生物多样性;辨证依据;诊疗

Research on the Relationship between the Types of Tongue Coating and Intestinal Flora in Patients with Colon Cancer

XIN Hong，TUO Luyao，CHU Xu，XU Wei

（The First Affiliated Hospital of Harbin Medical University，Harbin 150001，China）

Abstract Objective：To investigate the relationship between common tongue coating types and intestinal flora in patients with colon cancer.Methods：A total of 78 cases of colon cancer patients with 4 common tongue coating types admitted to the First Affiliated Hospital of Harbin Medical University from March 2019 to September 2019 were selected as research objects.The biodiversity and species composition of the flora of each group of patients were analyzed by high-throughput 16S rDNA sequencing.Results：Among the patients，there were 18 cases of thin moss，12 cases of thin yellow moss，22 cases of white moss and 26 cases of yellow moss.There were significant differences in intestinal flora diversity among patients with colon cancer with four kinds of tongue coating（all P<0.05）.At the level of phylum classification，the five phyla with the highest abundance in each group were Fimicutes，Proteobacteria，Bacteroidetes，Actinobacteria and Verrucomicrobia.At the taxonomic level，the richness of the top 10 genera in each group was mainly concentrated in Enterococcus，Escherichia/Shigella，Streptococcus，Klebsiella，Akkermansia，Lachnospiracea-incertae-sedis，Blautia，Bacteroides，Erysipelotrichaceae-incertae-sedis，Bifidobacterium.Conclusion：There are significant differences in biodiversity and species composition of intestinal flora with different tongue coating in patients with colon cancer，which provides experimental basis for further study on diagnosis and treatment of colon cancer based on tongue image change.

Keywords Colon cancer; Tongue coating type; Intestinal flora; Relationship; 16s rDNA; Biodiversity; Diagnosis; Treatment

中图分类号：R241;R735.3文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.17.024

结肠癌（Colon Cancer）是常见的消化道恶性肿瘤，其发生率居所有恶性肿瘤的第3位，死亡率居第2位[1-3]。研究发现结肠癌的发生发展与肠道微生态、代谢调节紊乱等因素密切相关[4-6]。中医药因具有多靶点、多途径等特点，在结肠癌的早期预防以及诊疗中具有重要优势;随着中医药在结肠癌的综合治疗中逐渐受到重视，中医药与结肠癌的临床研究也日益增多[7-9]。中医药在防治结肠癌方面一直以辨证论治为指导思想，证候是辨证论治和临床诊疗的基础，而中医舌诊在证候的判定中起到至关重要的作用。近年来，有研究表明舌苔的形成与舌苔上皮细胞中的促凋亡基因Bax、Fas、TGF-β3等的调控有关[10-11]。然而有关结肠癌患者舌苔类型与肠道菌群变化的研究相对较少，因此，探明结肠癌患者舌苔类型与肠道菌群变化的关系，对于结肠癌的中医药治疗能起到指导作用，并为结肠癌的辨证论治提供理论依据。……