肠道菌群失衡与急性胰腺炎易位感染的关系
|
摘要
目的探讨急性胰腺炎患者肠道菌群与胰腺炎易位感染的关系。方法前瞻性地募集重症急性胰腺炎患者171名,根据是否发生易位感染,分为急性胰腺炎非感染组(131名)和急性胰腺炎易位感染组(40名),所有入选者入院时收集粪便标本和血清,分别采用实时荧光定量PCR和分光光度法测定肠道菌群组成及肠道屏障功能,探讨肠道菌群与胰腺炎肠道屏障以及易位感染的关系。结果急性胰腺炎易位感染组患者入院时肠道菌群中的肠杆菌以及肠球菌含量较非感染组显著增加,实时荧光定量PCR结果发现感染组患者潜在致病菌如肠球菌、肠杆菌显著高于非感染组,与肠道黏膜屏障功能的内毒素水平、二胺氧化酶活性以及D-乳酸含量显著正相关,而双歧杆菌显著低于非感染组,与内毒素水平、二胺氧化酶活性以及D-乳酸含量显著负相关,结果提示肠道菌群失衡可能是急性胰腺炎易位感染发生的主要原因之一。结论肠道菌群失衡是急性胰腺炎易位感染发生的高危因素,与急性胰腺炎易位感染发生相关。
Objective To investigate the relationship between intestinal flora and pancreatitis translocation in acute pancreatitis.Methods 171 patients with severe acute pancreatitis were prospectively recruited and divided into non-infection group(131patients)or infection group(40patients)according to whether there was translocation infection.The specimens of stool and serum of the participants were collected on admission.Real-time quantitative PCR and spectrophotometry were used to determine the dominant intestinal flora and intestinal barrier function,respectively,and the relationship between intestinal flora and intestinal barrier and translocation of pancreatitis were observed.Results The numbers of Enterobacteriaand Enterococci in the infection group was significantly higher than those in the non-infection group,and were positively correlated with the levels of endotoxin and D-lactic acid and the activity of diamine oxidase in the intestinal mucosa.The number of Bifidobacteria was significantly lower in the infection group than in non infection group,and was negatively correlated with the levels of endotoxin and D-lactic acid and the activity of diamine oxidase in the intestinal mucosa.The results suggested that the imbalance of intestinal flora may be one of the important causes of translocation infection of acute pancreatitis.Conclusion Imbalance of intestinal flora is a high risk factor of translocation infection in acute pancreatitis,and is associated with translocation infection in acute pancreatitis.
Objective To investigate the relationship between intestinal flora and pancreatitis translocation in acute pancreatitis.Methods 171 patients with severe acute pancreatitis were prospectively recruited and divided into non-infection group(131patients)or infection group(40patients)according to whether there was translocation infection.The specimens of stool and serum of the participants were collected on admission.Real-time quantitative PCR and spectrophotometry were used to determine the dominant intestinal flora and intestinal barrier function,respectively,and the relationship between intestinal flora and intestinal barrier and translocation of pancreatitis were observed.Results The numbers of Enterobacteriaand Enterococci in the infection group was significantly higher than those in the non-infection group,and were positively correlated with the levels of endotoxin and D-lactic acid and the activity of diamine oxidase in the intestinal mucosa.The number of Bifidobacteria was significantly lower in the infection group than in non infection group,and was negatively correlated with the levels of endotoxin and D-lactic acid and the activity of diamine oxidase in the intestinal mucosa.The results suggested that the imbalance of intestinal flora may be one of the important causes of translocation infection of acute pancreatitis.Conclusion Imbalance of intestinal flora is a high risk factor of translocation infection in acute pancreatitis,and is associated with translocation infection in acute pancreatitis.
引文
[1] Li B,Selmi C,Tang R,et al.The microbiome and autoimmunity:A paradigm from the gut-liver axis[J].Cell Mol Immunol,2018,15(6):595-609.
[2] Postler TS,Ghosh S.Understanding the Holobiont:How microbial metabolites affect human health and shape the immune system[J].Cell Metab,2017,26(1):110-130.
[3] Tan CC,Ling ZX,Huang Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.
[4] TAN Chaochao,ZHU Yan,LUO Wenting,et al.The role of endotoxin in the early inflammatory response of acute pancreatitis[J].Chin J Health Lab Technol,2016,26(7):974-977.(in Chinese)谭超超,朱燕,罗文婷,等.史苇内毒素在急性胰腺炎早期炎症反应中的作用[J].中国卫生检验杂志,2016,26(7):974-977.
[5] TAN Chaochao,WU Yan,CAO Youde,et al.Diagnostic value of PCT in infected necrotizing pancreatitis PCT[J].China J Mod Med,2012,22(7):56-59.(in Chinese)谭超超,吴意,曹友德,等.PCT在感染性坏死性胰腺炎中的诊断价值[J].中国现代医学杂志,2012,22(7):56-59.
[6]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华肝胆外科杂志,2015,21(1):1-4.
[7] Warshaw AL.Improving the treatment of necrotizing pancreatitis--a step up[J].NEJM,2010,362(16):1535-1537.
[8] Muyzer G,de Waal EC,Uitterlinden AG.Profiling of complex microbial populations by denaturing gradient gel electrophoresis analysis of polymerase chain reaction-amplified genes coding for 16SrRNA[J].Appl Environ Microbiol,1993,59(3):695-700.
[9] HUANG Ying,TAN Chaochao.Analysis of the intestinal predominant microbiota in acute myocardial infarction patients[J].Chin J Microecol,2014,26(9):1004-1008.(in Chinese)黄莹,谭超超.急性心肌梗死患者肠道优势菌群分析[J].中国微生态学杂志,2014,26(9):1004-1008.
[10] Ling Z,Kong J,Jia P,et al.Analysis of oral microbiota in children with dental caries by PCR-DGGE and barcoded pyrosequencing[J].Microb Ecol,2010,60(3):677-690.
[11] TAN Chaochao,CAO Youde,ZENG Ling,et al.Clinical analysis of inflammatory cytokines in acute pancreatic patients[J].China J Mod Med,2012,22(13):67-70.(in Chinese)谭超超,曹友德,曾玲,等.急性胰腺炎血清炎性细胞因子的临床分析[J].中国现代医学杂志,2012,22(13):67-70.
[12] Kumar A,Chari ST,Vege SS.Can the time course of systemic inflammatory response syndrome score predict future organ failure in acute pancreatitis[J].Pancreas,2014,43(7):1101-1105.
[13] Van Minnen LP,Timmerman HM,Lutgendorff F,et al.Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis[J].Surgery,2007,141(4):470-480.
[14] WANG Weiqiang,CHEN Hanqing.Influence and curative effect of Bifidobacterium Tetravaccine Tablets on serum endotoxin and procalcitonin levels of patients with acute pancreatitis[J].Chin J Microecol,2014,26(6):671-673.(in Chinese)王卫强,陈涵清.双歧杆菌四联活菌片对急性胰腺炎患者血清内毒素和降钙素原水平的影响及疗效观察[J].中国微生态学杂志,2014,26(6):671-673.
[15] Lupp C,Robertson ML,Wickham ME,et al.Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae[J].Cell Host Microbe,2007,16(2):119-129.
[16] YE Jun,LYU Jianjie,PAN Jiefeng.Protective effect of Bifid Triple Viable Capsules on the function of intestinal mucosal barrier of patients with acute pancreatitis[J].Chin J Microecol,2014,26(4):441-443.(in Chinese)叶军,吕剑杰,潘杰锋.双歧三联活菌胶囊对急性胰腺炎患者肠黏膜屏障功能的保护作用[J].中国微生态学杂志,2014,26(4):441-443.
[2] Postler TS,Ghosh S.Understanding the Holobiont:How microbial metabolites affect human health and shape the immune system[J].Cell Metab,2017,26(1):110-130.
[3] Tan CC,Ling ZX,Huang Y,et al.Dysbiosis of intestinal microbiota associated with inflammation involved in the progression of acute pancreatitis[J].Pancreas,2015,44(6):868-875.
[4] TAN Chaochao,ZHU Yan,LUO Wenting,et al.The role of endotoxin in the early inflammatory response of acute pancreatitis[J].Chin J Health Lab Technol,2016,26(7):974-977.(in Chinese)谭超超,朱燕,罗文婷,等.史苇内毒素在急性胰腺炎早期炎症反应中的作用[J].中国卫生检验杂志,2016,26(7):974-977.
[5] TAN Chaochao,WU Yan,CAO Youde,et al.Diagnostic value of PCT in infected necrotizing pancreatitis PCT[J].China J Mod Med,2012,22(7):56-59.(in Chinese)谭超超,吴意,曹友德,等.PCT在感染性坏死性胰腺炎中的诊断价值[J].中国现代医学杂志,2012,22(7):56-59.
[6]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华肝胆外科杂志,2015,21(1):1-4.
[7] Warshaw AL.Improving the treatment of necrotizing pancreatitis--a step up[J].NEJM,2010,362(16):1535-1537.
[8] Muyzer G,de Waal EC,Uitterlinden AG.Profiling of complex microbial populations by denaturing gradient gel electrophoresis analysis of polymerase chain reaction-amplified genes coding for 16SrRNA[J].Appl Environ Microbiol,1993,59(3):695-700.
[9] HUANG Ying,TAN Chaochao.Analysis of the intestinal predominant microbiota in acute myocardial infarction patients[J].Chin J Microecol,2014,26(9):1004-1008.(in Chinese)黄莹,谭超超.急性心肌梗死患者肠道优势菌群分析[J].中国微生态学杂志,2014,26(9):1004-1008.
[10] Ling Z,Kong J,Jia P,et al.Analysis of oral microbiota in children with dental caries by PCR-DGGE and barcoded pyrosequencing[J].Microb Ecol,2010,60(3):677-690.
[11] TAN Chaochao,CAO Youde,ZENG Ling,et al.Clinical analysis of inflammatory cytokines in acute pancreatic patients[J].China J Mod Med,2012,22(13):67-70.(in Chinese)谭超超,曹友德,曾玲,等.急性胰腺炎血清炎性细胞因子的临床分析[J].中国现代医学杂志,2012,22(13):67-70.
[12] Kumar A,Chari ST,Vege SS.Can the time course of systemic inflammatory response syndrome score predict future organ failure in acute pancreatitis[J].Pancreas,2014,43(7):1101-1105.
[13] Van Minnen LP,Timmerman HM,Lutgendorff F,et al.Modification of intestinal flora with multispecies probiotics reduces bacterial translocation and improves clinical course in a rat model of acute pancreatitis[J].Surgery,2007,141(4):470-480.
[14] WANG Weiqiang,CHEN Hanqing.Influence and curative effect of Bifidobacterium Tetravaccine Tablets on serum endotoxin and procalcitonin levels of patients with acute pancreatitis[J].Chin J Microecol,2014,26(6):671-673.(in Chinese)王卫强,陈涵清.双歧杆菌四联活菌片对急性胰腺炎患者血清内毒素和降钙素原水平的影响及疗效观察[J].中国微生态学杂志,2014,26(6):671-673.
[15] Lupp C,Robertson ML,Wickham ME,et al.Host-mediated inflammation disrupts the intestinal microbiota and promotes the overgrowth of Enterobacteriaceae[J].Cell Host Microbe,2007,16(2):119-129.
[16] YE Jun,LYU Jianjie,PAN Jiefeng.Protective effect of Bifid Triple Viable Capsules on the function of intestinal mucosal barrier of patients with acute pancreatitis[J].Chin J Microecol,2014,26(4):441-443.(in Chinese)叶军,吕剑杰,潘杰锋.双歧三联活菌胶囊对急性胰腺炎患者肠黏膜屏障功能的保护作用[J].中国微生态学杂志,2014,26(4):441-443.