【摘要】：目的：探討老年骨骼肌量減少者的腸道菌群結(jié)構特點,以及老年骨骼肌量減少和腸道微生態(tài)變化的相關性。方法：本研究是橫斷面研究,從浙江大學附屬第一醫(yī)院老年醫(yī)學科電子病歷數(shù)據(jù)庫收集資料,研究對象是年齡大于或等于60歲的老年患者,即2013年6月1日至2015年12月31日期間在我科住院的老年患者,住院期間同時接受了骨骼肌雙能X線吸收檢測(Dual Energy X-ray Absorptiometry, DEXA)和糞便菌群檢查。DEXA測量與糞便標本采集的時間間隔小于三個月。研究對象排除了所有急性疾病、重癥、昏迷、或疾病終末期患者。采集患者糞便標本前一個月內(nèi)未給予抗生素、化療、放療、免疫抑制、益生菌或激素等影響腸道微生態(tài)結(jié)構的相關治療。根據(jù)患者的骨骼肌質(zhì)量是否減少分為2組：骨骼肌減少組與非骨骼肌減少組。老年骨骼肌量減少的診斷標準是DEXA測量指定骨骼肌質(zhì)量指數(shù)(skeletal mass index, SMI):男性小于7 kg/m2、女性小于5.4kg/m2。以定量PCR檢測患者的腸道微生態(tài)菌群豐度,以血紅蛋白水平和白蛋白水代表患者營養(yǎng)狀態(tài),以C反應蛋白水平代表患者的炎癥情況。結(jié)果：共59例患者納入本研究,依據(jù)SMI水平,共有48例老年患者的骨骼肌質(zhì)量減少。年齡(平均年齡84.2歲)、體重指數(shù)(平均BMI評分=23.9kg/m2)、血紅蛋白水平(平均值123g/L)、白蛋白水平(平均值39.6mg/L)和C反應蛋白水平(平均值2.3mg/L)在骨骼肌減少組與非骨骼肌減少組之間無統(tǒng)計學差異。兩組間患者的腸道菌群的豐度有統(tǒng)計差異,腸桿菌科細菌豐度與患者的骨骼肌質(zhì)量指數(shù)顯著負相關(相關系數(shù)=-0.31,p值=0.03),骨骼肌減少組的腸桿菌豐度比非骨骼肌減少組多7倍。此外,在骨骼肌減少組,致病菌腸桿菌的豐度與抗炎細菌群如普拉梭菌群、梭菌群Ⅳ、乳酸菌、雙歧桿菌的豐度呈正相關,與其它致病菌如梭菌cluster Ⅰ呈正相關。而在非骨骼肌減少組,致病腸桿菌的豐度與抗炎菌普氏菌的豐度呈負相關(相關系數(shù)=-0.7 p值=0.03)。此外,在骨骼肌減少組患者中,血紅蛋白水平與致病菌的豐度呈負相關。相反,在非骨骼肌減少組,血紅蛋白水平與抗炎菌普拉梭菌及乳桿菌的豐度呈正相關。結(jié)論：與以往的研究結(jié)果類似,中國人群中的老年骨骼肌肌量減少患者具有腸道菌群失調(diào),表現(xiàn)為致病性腸桿菌群的增加,同時此菌群的豐度與SMI值有負相關性。并且本研究最新發(fā)現(xiàn)患者的血紅蛋白水平與腸道菌群失調(diào)有相關性。今后通過進一步縱向研究,可以更明確老年骨骼肌量減少與腸道微生態(tài)改變的因果關系。
[Abstract]:Aim: to investigate the characteristics of intestinal microflora in elderly patients with decreased skeletal muscle volume and the correlation between the decrease of skeletal muscle volume and the changes of intestinal microecology. Methods: this study was a cross-sectional study. The data were collected from the electronic medical records database of geriatrics department of the first affiliated Hospital of Zhejiang University. The subjects of the study were elderly patients aged over or equal to 60 years old. From 1 June 2013 to 31 December 2015, the elderly patients who were hospitalized in the Department from 1 June 2013 to 31 December 2015, The time interval between (Dual Energy X-ray Absorptiometry, DEXA) and faecal microflora was less than three months. The subjects excluded all patients with acute, severe, coma, or end-stage disease. No antibiotics, chemotherapy, radiotherapy, immunosuppression, probiotics or hormones were given to the patients within one month before the collection of stool samples. The patients were divided into two groups according to the reduction of skeletal muscle mass: skeletal muscle reduction group and non-skeletal muscle reduction group. The diagnostic criteria for skeletal muscle loss in the elderly were DEXA measurements of the specific skeletal muscle mass index (skeletal mass index, SMI): male less than 7 kg/m2, and female less than 5.4 kg / m2. Quantitative PCR was used to detect the intestinal microflora abundance, hemoglobin level and albumin water were used to represent the nutritional status of the patients, and C-reactive protein level was used to represent the inflammatory status of the patients. Results: a total of 59 patients were included in this study. According to the SMI level, 48 elderly patients had decreased skeletal muscle mass. Age (mean age 84.2 years), body mass index (BMI score: 23.9kg / m ~ 2), hemoglobin (mean 123g/L), albumin (mean 39.6mg/L) and C-reactive protein (2.3mg/L) in skeletal and non-skeletal muscle reduction groups There was no statistical difference between the two groups. There was statistical difference in the abundance of intestinal flora between the two groups. There was a significant negative correlation between the bacterial abundance of Enterobacteriaceae and the skeletal muscle mass index (correlation coefficient was 0.03). The intestinal bacillus abundance in the group of skeletal muscle reduction was 7 times higher than that in the group of non-skeletal muscle reduction. In addition, there was a positive correlation between the abundance of Enterobacter spp. And the abundance of anti-inflammatory bacteria such as Clostridium praziae, Clostridium clostridium 鈪，

本文編號：2218173