Role of fecal microbiota transplantation in treating slow transit constipation based on 16S rDNA detection
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摘要:目的
通过16S rDNA检测技术探讨慢传输型便秘(STC)患者肠道菌群特点以及肠道菌群移植(FMT)的作用。
方法选取30例STC患者作为STC组，给予2个疗程的规范化FMT治疗; 选取同期20例健康成年人作为对照组。采用粪便16S rDNA测序技术对STC组和对照组肠道菌群进行比较，并对STC患者实施FMT前后的肠道菌群进行比较。
结果与对照组相比, STC组肠道菌群多样性降低，厚壁菌门相对丰度降低，而变形菌门和梭杆菌门相对丰度升高，差异均有统计学意义(P < 0.05)。经FMT治疗后，功能性便秘患者菌群多样性升高，差异有统计学意义(P < 0.05); 在门水平上, STC患者实施FMT后拟杆菌门和梭状菌门相对丰度降低，而厚壁菌门和变形菌门相对丰度升高，差异有统计学意义(P < 0.05)。STC组胃肠生活质量评分(GIQLI)、Wexner便秘评分均较治疗前下降，差异有统计学意义(P < 0.05)。STC组抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、匹兹堡睡眠质量评分(PSQI)均较治疗前下降，差异有统计学意义(P < 0.05)。
结论STC患者肠道菌群易发生紊乱，菌群多样性及分布发生改变。FMT可通过调节肠道菌群来改善便秘症状，改变肠道菌群的分布和多样性。
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关键词:
- 慢传输型便秘 /
- 肠道菌群 /
- 肠道菌群移植 /
- 16S rDNA检测技术
Abstract:ObjectiveTo investigate the characteristics of intestinal flora in patients with slow transit constipation (STC) and role of fecal microbiota transplantation (FMT) by 16S rDNA sequencing technology.
MethodsA total of 30 patients with STC were selected as STC group, and they were treated with standardized FMT therapy for two courses; another 20 healthy adults in the same period were selected as control group. Fecal 16S rDNA sequencing technology was used to compare the intestinal flora between the control group and the STC group, and the intestinal flora before and after FMT in patients with STC was compared.
ResultsCompared with the control group, the diversity of intestinal flora in the STC group decreased significantly, the relative abundance of Firmicutes decreased significantly, and the relative abundances of Proteobacteria and Fusobacteria increased significantly (P < 0.05). After FMT treatment, the diversity of flora in patients with functional constipation increased significantly (P < 0.05); at the phylum level, the relative abundances of Bacteroidetes and Fusobacteria decreased significantly while the relative abundances of Firmicutes and Proteobacteria increased significantly in STC patients after implementing FMT (P < 0.05). The Gastrointestinal Quality of Life Index (GIQLI) score and Wexner constipation score in the STC group decreased significantly after treatment when compared to those before treatment (P < 0.05). The Self-rating Depression Scale (SDS) score, Self-rating Anxiety Scale (SAS) score and Pittsburgh Sleep Quality Index (PSQI) score in the STC group decreased significantly after treatment when compared to those before treatment (P < 0.05).
ConclusionSTC patients are prone to disruption of intestinal flora, resulting in changes of microbial diversity and distribution. FMT can improve constipation symptoms and change the distribution and diversity of intestinal flora by regulating intestinal flora.
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表 1 STC组和对照组粪便菌群比较(x ± s[M(IQR)]
组别 菌群多样性 厚壁菌门 拟杆菌门 变形菌门 放线菌门 梭杆菌门 STC组 2.00±0.76 0.29±0.24 0.34±0.25 0.25±0.20 0.03(0.01~0.05) 0.01(0~0.07) 对照组 2.84±0.84* 0.45±0.21* 0.37±0.28 0.12±0.11* 0.05(0.01~0.07) 0.02(0~0.01)* 与STC组比较, *P<0.05。 
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表 2 STC患者FMT前后粪便菌群比较(x ± s)[M(IQR)]
时点 菌群多样性 厚壁菌门 拟杆菌门 变形菌门 放线菌门 梭杆菌门 FMT前 2.00±0.76 0.29±0.24 0.34±0.25 0.25±0.20 0.03(0.01~0.05) 0.01(0~0.07) FMT后 2.60±0.47* 0.47±0.11* 0.10±0.10* 0.33±0.16* 0.04(0.01~0.09) 0(0~0.02)* 与FMT前比较, *P<0.05。
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表 3 STC患者实施FMT前后精神心理评估及疗效评估(x ± s)
分 时点 SDS评分 SAS评分 PSQI GIQLI Wexner便秘评分 FMT前 44.73±9.18 44.50±7.62 10.03±3.98 66.63±16.36 15.17±1.49 FMT后 39.03±8.20* 35.77±7.47* 8.23±2.70* 50.40±16.13* 2.27±1.14* SDS: 抑郁自评量表; SAS: 焦虑自评量表; PSQI: 匹兹堡睡眠质量评分; GIQLI: 胃肠生活质量指数。与FMT前比较, *P<0.05。
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表 4 STC患者实施FMT前后BMI和血检指标比较(x ± s)
时点 BMI/(kg/m2) RBC/(×1012/L) WBC/(×109/L) ALT/(U/L) AST/(U/L) CREA/(μmol/L) UREA/(mmol/L) FMT前 22.27±2.08 4.12±0.62 4.27±0.68 16.14±6.14 30.03±8.88 66.97±10.45 4.70±1.19 FMT后 22.30±2.02 4.14±0.55 4.29±0.51 14.57±4.17 28.03±5.88 66.67±9.85 4.49±0.93
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