本文選題：非酒精性脂肪性肝病 + 腸道菌群失調(diào)�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景非酒精性脂肪性肝病(nonalcoholic fatty liver disease,NAFLD)是以肝臟過量脂肪浸潤為病理特點(diǎn)的一種代謝性肝臟損傷,目前已成為最常見的慢性肝臟疾病。新近研究發(fā)現(xiàn),腸道菌群失調(diào)與NAFLD的發(fā)生、發(fā)展相關(guān)。腸道菌群失調(diào)是導(dǎo)致腸道炎癥的重要因素,而腸道炎癥狀態(tài)在NAFLD中的研究鮮見報(bào)道,腸道菌群失調(diào)與腸道炎癥在NAFLD中的作用值得進(jìn)一步探討。目的明確NAFLD患者腸道菌群結(jié)構(gòu)特點(diǎn)及腸道炎癥狀態(tài)。方法研究納入2015年5月～2016年8月在南京軍區(qū)南京總院門診就診的81例NAFLD患者,并選取同期本院體檢中心91例體檢者作為健康對照。收集入選對象的血清及糞便樣品,分別進(jìn)行血液生化學(xué)檢測及糞便鈣衛(wèi)蛋白(fecal calprotectin,FC)檢測(ELISA法)。此外,其中的24例NAFLD患者及18例對照者的糞便樣品進(jìn)行16SrRNA測序。兩組間比較采用獨(dú)立樣本的T檢驗(yàn),計(jì)數(shù)資料采用X2檢驗(yàn)。采用Spearman法進(jìn)行相關(guān)性分析,采用Logistic回歸進(jìn)行多因素分析。統(tǒng)計(jì)分析采用SPSS 20.0軟件進(jìn)行分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.一般情況:NAFLD組的體質(zhì)指數(shù)(BMI)、腰圍、尿酸、血糖、AST、ALT、GGT、TC、TG及LDL的水平均明顯高于健康對照組;NAFLD組HDL的水平低于健康對照組;多因素分析發(fā)現(xiàn)TG、TC、HDL及BMI是NAFLD發(fā)病的獨(dú)立危險因子。2.腸道菌群組成分析:厚壁菌門、擬桿菌門、變形菌門以及放線菌門是兩組研究對象腸道中的四大優(yōu)勢菌門,其占細(xì)菌總量的95%以上。在細(xì)菌門分類學(xué)水平上,擬桿菌門在NAFLD組中的豐度(30.46%)低于健康對照組(46.43%)(P0.05),變形菌門在NAFLD組的豐度(23.21%)高于健康對照組(7.99%)(P0.05),NAFLD患者糞菌中變形菌門/擬桿菌門比值較健康對照組顯著升高(P0.01),厚壁菌門及放線菌門的豐度差異在兩組間無統(tǒng)計(jì)學(xué)意義;在細(xì)菌科及屬的分類學(xué)水平上,NAFLD組患者糞菌中擬桿菌科、擬桿菌屬的豐度顯著低于健康對照組(P0.01),大腸桿菌科及埃希氏菌屬的豐度則顯著高于健康對照組(P0.01),埃希菌屬/擬桿菌屬比值顯著高于健康對照組(P0.01)。3.FC檢測:NAFLD組的FC平均濃度(43.0(18.8-87.0)μg/g)高于正常對照組(11.4(4.6-24.4)μg/g)(P0.001)。FC水平與BMI、TC及GGT的水平均具有相關(guān)性,相關(guān)系數(shù)分別為0.725(P0.001)、0.292(P =0.010)及0.400(P0.01)。4.腸道菌群失調(diào)與FC相關(guān)性分析:FC濃度與埃希氏菌屬的豐度呈正相關(guān)(r=0.644,P0.001),與擬桿菌屬的豐度呈負(fù)相關(guān)(r=-0.426,P= 0.038),與埃希菌屬/擬桿菌屬豐度的比值呈顯著正相關(guān)(r=0.810,P0.001)。結(jié)論NAFLD患者存在腸道炎癥,以及以埃希氏菌屬/擬桿菌屬豐度比值升高為特征的菌群失調(diào),二者之間存在良好的相關(guān)性。腸道菌群菌群失調(diào)及腸道炎癥可能與NAFLD的發(fā)生發(fā)展相關(guān)。
[Abstract]:Background Non-alcoholic fatty liver disease (NAF LDD) is a metabolic liver injury characterized by excessive fatty infiltration of the liver. It has become the most common chronic liver disease. Recent studies have found that intestinal dysbacteriosis is associated with the occurrence and development of NAFLD. Intestinal dysbacteriosis is an important factor leading to intestinal inflammation, and the study of intestinal inflammatory status in NAFLD is rarely reported. The role of intestinal dysbacteriosis and intestinal inflammation in NAFLD should be further discussed. Objective to identify the intestinal flora and intestinal inflammation in patients with NAFLD. Methods from May 2015 to August 2016, 81 patients with NAFLD were enrolled in the outpatient clinic of Nanjing General Hospital of Nanjing military region, and 91 medical examiners in the same period were selected as healthy control. Serum and fecal samples were collected, blood biochemistry and fecal calcitonin were detected by Elisa. In addition, stool samples from 24 NAFLD patients and 18 controls were sequenced by 16SrRNA. The T test of independent samples and X 2 test were used to compare the data between the two groups. Correlation analysis was carried out by Spearman method and multivariate analysis by Logistic regression. Statistical analysis using SPSS 20.0 software to analyze the difference was statistically significant. Result 1. In general, the body mass index (BMI), waist circumference, uric acid, TG and LDL levels in the 10% NAFLD group were significantly higher than those in the healthy control group, and the multivariate analysis showed that TGP HDL and BMI were the independent risk factors of NAFLD. The composition of intestinal microflora: phylum, Bacteroides, Proteus and Actinomycetes were the four dominant phylum in the intestinal tract of the two groups, which accounted for more than 95% of the total number of bacteria. At the level of phylum taxonomy, The abundance of Bacteroides in NAFLD group (30.46) was lower than that in healthy control group (46.43) and the abundance of Proteus in NAFLD group (23.21) was higher than that in healthy control group (P 0.05%). The ratio of Proteus to Bacteroides in fecal bacteria in patients with NAFLD was significantly higher than that in healthy control group (P 0.01), and the ratio of Proteus to Bacteroides in healthy control group was significantly higher than that in healthy control group. There was no significant difference between the two groups in the abundance of actinomycetes and actinomycetes. Bacteroides in faecal bacteria of NAFLD group at the taxonomic level of the family Bacteriaceae and genera, The abundance of Bacteroides is significantly lower than that of the healthy control group (P 0.01), the abundance of Escherichia coli and Escherichia coli is significantly higher than that of the healthy control group (P 0.01), and the ratio of Escherichia coli to Bacteroides is significantly higher than that of the healthy control group. The average concentration of BMITC and GGT were significantly higher than those of normal control group (P < 0.05), the mean concentration of BMITC was 18.8-87.0 渭 g / g), and the level of BMITC and GGT was significantly higher than that of normal control group (11.4 渭 g/g)(P0.001).FC, 4.6-24.4 渭 g / g). The correlation coefficients were 0.725 (P 0.001), 0.292 (P) 0.010) and 0.400 (P 0.01) 路4, respectively. Analysis of correlation between intestinal flora imbalance and FC A positive correlation was found between the concentration of 10% FC and the abundance of Escherichia spp. 0.644m P0.001C, negatively correlated with the abundance of Bacteroides, r = 0.426 (P = 0.038), and with the ratio of the abundance of Escherichia / Bacteroides (R0.810P0.001). Conclusion there are intestinal inflammation in patients with NAFLD and the imbalance of flora characterized by the increase of the abundance ratio of Escherichia coli to Bacteroides, and there is a good correlation between them. Intestinal flora imbalance and intestinal inflammation may be related to the occurrence and development of NAFLD.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575

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本文編號：1921672