本文選題：艾滋病 + 腸道微生態(tài)��； 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：艾滋病是一種由人類免疫缺陷病毒引起的免疫缺陷性疾病。我國HIV感染有如下特點：整體疫情依然呈上升趨勢，但增速減緩；HIV感染者發(fā)病進(jìn)入高發(fā)期，死亡人數(shù)增加；十二五規(guī)劃提出，將提高艾滋病病毒感染者和艾滋病病人的生活質(zhì)量做為一項目標(biāo)。艾滋病作為一種無法治愈的疾病，影響其生存質(zhì)量的主要原因是各種并發(fā)癥的發(fā)生。近些年研究發(fā)現(xiàn)，腸道菌群與人體健康有著密切的關(guān)系。腸道微生態(tài)失衡是導(dǎo)致免疫低下患者內(nèi)源性感染發(fā)生的主要原因之一，所以研究艾滋病患者腸道微生態(tài)的變化具有重大意義。 研究目的: 本研究旨對正常健康成人與艾滋病非腹瀉患者及艾滋病腹瀉患者糞便中腸道菌群失調(diào)程度進(jìn)行比較，及5種代表菌進(jìn)行定量分析，比較其腸道菌群失調(diào)的差異，研究艾滋病患者腸道微生態(tài)的變化，并研究其與CD4+T/CD8+T淋巴細(xì)胞數(shù)值、血液培養(yǎng)陽性及消化道癥狀等的關(guān)系。希望可以為臨床醫(yī)生對艾滋病患者腸道微生態(tài)狀況了解提供理論依據(jù)。 研究方法： 59例艾滋病非腹瀉患者作為實驗組，30例健康成人作為對照組，22例艾滋病腹瀉患者作為腹瀉組，革蘭氏染色涂片觀察進(jìn)行腸道菌群失調(diào)分度，選擇腸道菌群中具有代表性的5種菌（雙歧桿菌、腸球菌、腸桿菌、乳酸桿菌、真菌）進(jìn)行細(xì)菌培養(yǎng)及計數(shù)，并計算反映腸道定值抗力的指標(biāo)B/E值。 研究結(jié)果： 1.腸道菌群失調(diào)程度比較： 三組兩兩比較差異均有統(tǒng)計學(xué)意（P0.001），正常組的腸道菌群分度以正常的居多（86.7%），實驗組的以Ⅰ度（66.1%）的居多，腹瀉組也以Ⅰ度（63.6%）的居多，但Ⅱ度的比例(31.6%)明顯比正常組(0%)和實驗組（5.1%）多。 2.腸道菌落比較： 三組之間的糞便細(xì)菌數(shù)量有差異，其中(1)腸桿菌：正常人組的腸桿菌多于腹瀉組（P=0.015），實驗組的腸桿菌多于腹瀉組（P=0.011），正常人組與實驗組比較差異無統(tǒng)計學(xué)意義(P=0.487)；(2)腸球菌：實驗組的腸球菌多于正常人組（P0.001），腹瀉組的腸球菌多于正常組（P=0.016），實驗組與腹瀉組比較差異無統(tǒng)計學(xué)意義（P=0.664）；(3)雙歧桿菌：實驗組的雙歧桿菌多于腹瀉組（P=0.002）。正常組與實驗組及腹瀉組比較差異均無統(tǒng)計學(xué)意義（P值分別為0.323、0.344）。（4）真菌：實驗組的真菌多于正常人組（P=0.002），，腹瀉組的真菌多于正常組（P0.001），實驗組與腹瀉組比較差異無統(tǒng)計學(xué)意義（P=0.441）。（5）乳酸桿菌及B/E值：三組的乳酸桿菌及B/E值比較差異無統(tǒng)計學(xué)意義（P0.05）。 3.五種代表菌數(shù)量、B/E值、腸道菌群失調(diào)分度之間的相關(guān)分析： 腸道菌群分度與腸桿菌（P=0.016）、乳酸桿菌（P0.001）呈負(fù)相關(guān)，與腸球菌(P0.001)、真菌(P0.001)呈正相關(guān)；腸桿菌與B/E值（P0.001）、腸道菌群分度(P=0.016)呈負(fù)相關(guān),與雙歧桿菌（P=0.026）、乳酸桿菌（P0.001）呈正相關(guān)；腸球菌與腸道菌群分度（P0.001）及雙歧桿菌（P0.001）呈正相關(guān)；雙歧桿菌與腸桿菌（P=0.026）、腸球菌（P0.001）、乳酸桿菌（P0.001）、B/E值（P0.001）均呈正相關(guān)；乳酸桿菌與腸桿菌（P0.001）、雙歧桿菌（P0.001）呈正相關(guān)，與腸道菌群分度（P0.001）呈負(fù)相關(guān)；真菌與腸道菌群分度（P0.001）呈正相關(guān)。 4.五種代表菌數(shù)量、腸道菌群失調(diào)分度及B/E值與淋巴細(xì)胞的相關(guān)分析： CD4+T淋巴細(xì)胞與腸球菌（P=0.008）、真菌（P=0.044）、腸道菌群分度(P0.001)均呈負(fù)相關(guān)；CD8+T淋巴細(xì)胞與乳酸桿菌(P=0.001)呈正相關(guān)，與真菌(P=0.001)、腸道菌群分度(P=0.006)呈負(fù)相關(guān)，與其他菌及B/E的相關(guān)無統(tǒng)計學(xué)意義。 5.五種代表菌數(shù)量、腸道菌群失調(diào)分度及B/E值與血液培養(yǎng)陽性的相關(guān)分析： 血液培養(yǎng)結(jié)果陽性與雙歧桿菌（P=0.019）、B/E值(P=0.010)呈負(fù)相關(guān)；其中血液培養(yǎng)中馬爾尼菲青霉菌病與B/E值呈負(fù)相關(guān)(P=0.036)； 6.五種代表菌數(shù)量、腸道菌群失調(diào)分度及B/E值與消化道癥狀的相關(guān)分析： 腹痛腹瀉病程及平均每天次數(shù)與腸桿菌、雙歧桿菌、乳酸桿菌呈負(fù)相關(guān)(P0.05)，與腸道菌群失調(diào)分度呈正相關(guān)(P0.05)； 結(jié)論：艾滋病患者與正常人腸道微生態(tài)有差異，提示其腸道紊亂，且與CD4+TCD8+T淋巴細(xì)胞數(shù)值、血液培養(yǎng)陽性及患者的消化道癥狀均存在相關(guān)性。
[Abstract]:AIDS is an immunodeficiency disease caused by the human immunodeficiency virus. The HIV infection in China has the following characteristics: the overall epidemic is still on the rise, but the growth rate slows down; the incidence of HIV infected people is high and the death toll increases; the plan proposed in 12th Five-Year will improve the lives of HIV infected people and AIDS patients. Quality is a goal. As an untreatable disease, the main cause of the quality of life is the occurrence of various complications. In recent years, studies have found that intestinal microflora is closely related to human health. Intestinal microecological imbalance is one of the main causes of endogenous infection in immunocompromised patients. It is of great significance to study the changes of intestinal microecology in AIDS patients.
The purpose of the study is:
The purpose of this study was to compare the intestinal flora imbalance between normal healthy adults and non diarrhea patients with AIDS and AIDS diarrhea, and the quantitative analysis of 5 representative bacteria, compare the difference of intestinal flora imbalance, study the changes of intestinal microecology of AIDS patients, and study the value of CD4+T/CD8+T lymphocyte and blood. We hope to provide a theoretical basis for clinicians to understand the intestinal microflora of AIDS patients.
Research methods:
59 cases of non diarrhea patients with AIDS were used as experimental group, 30 healthy adults as control group, 22 cases of AIDS and diarrhea as diarrhea group and Gram stain smear to observe intestinal flora imbalance, and select 5 representative bacteria (bifidobacteria, Enterococcus, enterobacter, lactobacilli, fungi) in intestinal microflora. Count and calculate the B/E value reflecting the resistance value of the intestinal tract.
The results of the study:
1. the degree of maladjustment of intestinal flora was compared.
The differences of the three groups were statistically significant (P0.001). The intestinal microflora in the normal group was more than normal (86.7%), the experimental group was mostly I (66.1%), and the diarrhea group was mostly in the degree of I (63.6%), but the proportion of the second degree (31.6%) was significantly higher than that of the normal group (0%) and the experimental group (5.1%).
2. comparison of intestinal colonies:
The number of fecal bacteria between the three groups was different, including (1) Enterobacteriaceae: intestinal bacilli in the normal group was more than the diarrhea group (P=0.015), the Enterobacteriaceae in the experimental group was more than the diarrhea group (P=0.011), and there was no significant difference between the normal group and the experimental group (P=0.487); (2) the Enterococcus in the experimental group was more than the normal group (P0.001) and the diarrhea group. There were more Enterococcus than in the normal group (P=0.016), and there was no significant difference between the experimental group and the diarrhea group (P=0.664). (3) bifidobacteria: bifidobacteria in the experimental group was more than the diarrhea group (P=0.002). There was no significant difference between the normal group and the experimental group and the diarrhea group (P value 0.323,0.344). (4) the fungi in the experimental group were more than the positive. The normal group (P=0.002), the fungi in the diarrhea group were more than the normal group (P0.001). There was no significant difference between the experimental group and the diarrhea group (P=0.441). (5) the lactic acid bacilli and the B/E value: there was no statistical difference between the three groups of lactobacilli and B/E (P0.05).
3. correlation analysis of the number of five representative bacteria, B/E value and imbalance of intestinal flora.
Intestinal microflora was negatively correlated with Enterobacteriaceae (P=0.016), Lactobacillus (P0.001), positive correlation with Enterococcus (P0.001) and fungi (P0.001); Enterobacteriaceae was negatively correlated with B/E (P0.001), intestinal flora diversity (P=0.016), positive correlation with Bifidobacterium (P=0.026) and Lactobacillus (P0.001); Enterococcus and intestinal microflora (P0.001) and bifidus Bacilli (P0.001) was positively correlated; Bifidobacterium was positively correlated with Enterobacteriaceae (P=0.026), Enterococcus (P0.001), Lactobacillus (P0.001) and B/E (P0.001); Lactobacillus was positively correlated with Enterobacteriaceae (P0.001), Bifidobacterium (P0.001) and negatively correlated with intestinal microflora (P0.001); fungi and intestinal microflora (P0.001) were positively correlated.
4. the correlation between the number of five representative bacteria, the imbalance of intestinal flora and the B/E value and lymphocytes.
CD4+T lymphocytes were negatively correlated with Enterococcus (P=0.008), fungi (P=0.044) and intestinal microflora (P0.001), CD8+T lymphocytes were positively correlated with Lactobacillus (P=0.001), and negatively correlated with fungi (P=0.001) and intestinal microflora fraction (P=0.006), and had no statistical significance with other bacteria and B/E.
5. the correlation between the number of five representative bacteria, the imbalance of intestinal flora, the B/E value and the positive blood culture:
The results of positive blood culture were negatively correlated with P=0.019 and B/E value (P=0.010), and in the blood culture, penicilliosis marneffia was negatively correlated with the value of B/E (P=0.036).
6. the correlation between the number of five representative bacteria, the imbalance of intestinal flora, B/E and gastrointestinal symptoms:
The duration of abdominal pain, diarrhea and the average daily number were negatively correlated with Enterobacteriaceae, bifidobacteria and Lactobacillus (P0.05), and positively correlated with the imbalance of intestinal flora (P0.05).
Conclusion: the intestinal microecology of AIDS patients and normal people is different, indicating the intestinal disorder, and the correlation with the CD4+TCD8+T lymphocyte value, the positive blood culture and the symptoms of the digestive tract of the patients.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R512.91

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