本文選題：干細(xì)胞移植　切入點(diǎn)：腸道菌群　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]本研究通過(guò)對(duì)干細(xì)胞移植患者與正常對(duì)照者之間糞便菌群種類及特異菌群的定量研究,了解干細(xì)胞移植患者腸道菌群結(jié)構(gòu)差異及數(shù)量的變化,并探討干細(xì)胞移植患者是否出現(xiàn)腸道細(xì)菌結(jié)構(gòu)紊亂從而引起院內(nèi)感染。[方法]本研究為前瞻性,觀察性研究。根據(jù)入選標(biāo)準(zhǔn),納入復(fù)旦大學(xué)附屬華東醫(yī)院血液科進(jìn)行干細(xì)胞移植的患者,收集患者干細(xì)胞移植前7-10天、干細(xì)胞移植后7-10天,干細(xì)胞移植后發(fā)生感染時(shí)的糞便標(biāo)本。另外收集20個(gè)正常人的糞便標(biāo)本作為對(duì)照。根據(jù)細(xì)菌的16SrDNA基因序列設(shè)計(jì)大腸埃希菌、糞腸球菌屬、乳酸桿菌屬、及擬桿菌屬的引物,運(yùn)用實(shí)時(shí)熒光定量-聚合酶鏈反應(yīng)法(RT-PCR)定量檢測(cè)兩組患者中這四種細(xì)菌的數(shù)量變化。[結(jié)果]經(jīng)RT-PCR對(duì)大腸埃希菌、腸球菌屬、乳酸桿菌屬、擬桿菌屬定量檢測(cè)后發(fā)現(xiàn)：1.HSCT患者3組相比：造血干細(xì)胞移植后發(fā)生感染時(shí)、干細(xì)胞移植前7-10天及干細(xì)胞移植后7-10天相比,糞便中3種細(xì)菌(大腸埃希菌、腸球菌屬、和乳酸桿菌屬)數(shù)量增多,其變化量分別為大腸埃希菌8.66±2.65 vs 8.55±1.1l vs 7.97±0.49, p=0.735；腸球菌屬7.47±1.75 vs 6.70±1.76 vs 7.09±1.54, p=0.14:乳酸桿菌9.03±0.29 vs 7.57±0.28 vs 8.69±0.19 p=0.009.而在造血干細(xì)胞移植后7-10天,患者腸道中擬桿菌屬數(shù)量增加,與造血干細(xì)胞移植后發(fā)生感染時(shí)及干細(xì)胞移植前7-10天相比,分別為6.74±0.19 vs 6.58±0.28 vs 6.67±0.24, p=0.964。2.造血干細(xì)胞移植后發(fā)生感染時(shí)腸道細(xì)菌數(shù)量較對(duì)照組增加,分別為大腸埃希菌8.66±2.65 vs 8.51±0.54,p=0.795,腸球菌屬7.47±1.75 vs7.11±1.06,p=0.000,乳酸桿菌屬9.03±0.29 vs 8.67±0.43,p=0.72,擬桿菌屬6.67±0.24 vs 6.66±0.28,p=0.243。與對(duì)照組相比,造血干細(xì)胞移植前7-10天患者腸道中大腸埃希菌及糞球菌屬數(shù)量下降,分別為7.97±0.49vs 8.51±0.54,p=0.417；7.09±1.54 vs 7.11±1.06,p=0.580。而乳酸桿菌屬及擬桿菌屬數(shù)量增多,分別為8.69±0.19 vs 8.67±0.43,p=0.954；6.74±0.19vs 6.66±0.28,p=0.85.3. HSCT患者3個(gè)采樣點(diǎn)比較,只有乳酸桿菌屬數(shù)量有顯著差異(p=0.009),其他菌種之間無(wú)顯著差異(p0.05)。而造血干細(xì)胞移植后發(fā)生感染時(shí)與對(duì)照組相比,4種細(xì)菌都有所增加,分別為大腸埃希菌8.66±2.65 vs 8.51±0.54,腸球菌屬7.47±1.75 vs 7.11±1.06,乳酸桿菌屬9.03±0.29 vs 8.67±0.43和擬桿菌屬6.67±0.24 vs6.66±0.28),但只有腸球菌屬的差異具有統(tǒng)計(jì)學(xué)意義(p=0.000)。4.造血干細(xì)胞移植前7-10天大便菌群數(shù)量總體較對(duì)照組有所下降,但只乳酸桿菌屬的差異具有統(tǒng)計(jì)學(xué)意義(p=0.002)。[結(jié)論]1.與對(duì)照組相比,造血干細(xì)胞移植后發(fā)生感染時(shí)腸道細(xì)菌明顯增多。當(dāng)造血干細(xì)胞移植后發(fā)生感染時(shí)腸道細(xì)菌結(jié)構(gòu)發(fā)生改變。2.當(dāng)造血干細(xì)胞移植后發(fā)生感染時(shí)腸道細(xì)菌結(jié)構(gòu)發(fā)生改變,主要為腸道兼性厭氧細(xì)菌,其中以乳酸桿菌屬及大腸埃希菌最為顯著。3. Real-time PCR方法檢測(cè)糞便中細(xì)菌DNA能反映腸道細(xì)菌改變。
[Abstract]:[objective] to investigate the difference and quantity of intestinal flora in stem cell transplantation patients by quantitative analysis of fecal microflora and specific microflora between stem cell transplantation patients and normal controls. And to explore whether stem cell transplantation patients have intestinal bacterial structure disorder and cause nosocomial infection. [methods] this study is a prospective, observational study, according to the inclusion criteria, Patients admitted to the Department of Hematology of Huadong Hospital affiliated to Fudan University for stem cell transplantation were collected 7-10 days before transplantation and 7-10 days after stem cell transplantation. Fecal specimens from infected stem cells were collected from 20 normal controls. Primers were designed for Escherichia coli, Enterococcus faecalis, Lactobacillus and Bacteroides according to the 16s rDNA gene sequence of bacteria. Real-time fluorescence quantification-polymerase chain reaction (RT-PCR) was used to detect the quantitative changes of the four bacteria in the two groups. [results] RT-PCR was used to detect Escherichia coli, Enterococcus and Lactobacillus. The results of quantitative analysis of Bacteroides showed that: 1. Three kinds of bacteria (Escherichia coli, Enterococcus) were found in feces when infection occurred after hematopoietic stem cell transplantation, 7-10 days before stem cell transplantation and 7-10 days after stem cell transplantation. The number of Escherichia coli (8.66 鹵2.65 vs 8.55 鹵1.41 vs 7.97 鹵0.49, pn0.735), Enterococcus 7.47 鹵1.75 vs 6.70 鹵1.76 vs 7.09 鹵1.54, p0.14: Lactobacillus 9.03 鹵0.29 vs 7.57 鹵0.28 vs 8.69 鹵0.19 pc0.0099.The number of bacilli in intestinal tract increased 7-10 days after hematopoietic stem cell transplantation. Compared with infection after hematopoietic stem cell transplantation and 7 to 10 days before stem cell transplantation, the number of intestinal bacteria was increased after hematopoietic stem cell transplantation compared with that in control group, which was 6.74 鹵0.19 vs 6.58 鹵0.28 vs 6.67 鹵0.24, and 0.964.2, respectively. The number of Escherichia coli was 8.66 鹵2.65 vs 8.51 鹵0.54p 0.795. Enterococcus was 7.47 鹵1.75 vs7.11 鹵1.06p0.000. Lactobacillus was 9.03 鹵0.29 vs 8.67 鹵0.43p0.72, bacillus was 6.67 鹵0.24 vs 6.66 鹵0.28p0.243. Compared with the control group, the number of Escherichia coli and S. faecalis decreased 7-10 days before hematopoietic stem cell transplantation. It was 7.97 鹵0.49 vs 8.51 鹵0.54 鹵0.4177.09 鹵1.54 vs 7.11 鹵1.06 p0. 580.The number of Lactobacillus and Bacteroides increased 8.69 鹵0.19 vs 8.67 鹵0.43p0. 74 鹵0. 19 vs 6. 66 鹵0. 28p0. 85.3. HSCT. Only the number of Lactobacillus was significantly different from that of the control group, but there was no significant difference among other strains. However, the number of four bacteria increased after hematopoietic stem cell transplantation (HSCT) compared with the control group. Escherichia coli 8.66 鹵2.65 vs 8.51 鹵0.54, Enterococcus 7.47 鹵1.75 vs 7.11 鹵1.06, Lactobacillus 9.03 鹵0.29 vs 8.67 鹵0.43 and Bacteroides 6.67 鹵0.24 vs6.66 鹵0.28, respectively, but only Enterococcus showed significant difference in the number of feces from 7 to 10 days before hematopoietic stem cell transplantation. The control group decreased, But the difference of Lactobacillus is statistically significant. [conclusion] 1.Compared with the control group, After hematopoietic stem cell transplantation (HSCT), the intestinal bacterial structure was changed. 2. When the infection occurred after hematopoietic stem cell transplantation (HSCT), the intestinal bacterial structure changed, and the infection occurred after hematopoietic stem cell transplantation (HSCT). The main intestinal facultative anaerobic bacteria were Lactobacillus and Escherichia coli. The detection of bacterial DNA in feces by Real-time PCR could reflect the change of intestinal bacteria.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R574

【共引文獻(xiàn)】

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