| 翁卫东,柴可群.清肺通络合剂对气阴两虚兼痰热型社区获得性肺炎患者肠道菌群多样性的影响[J].浙江中西医结合杂志,2023,33(2): |
| 清肺通络合剂对气阴两虚兼痰热型社区获得性肺炎患者肠道菌群多样性的影响 |
| Effect of QingfeitongluoMixture on intestinal flora diversity in patients with community-acquired pneumonia with deficiency of both qi and yin and phlegm-heat type |
| 投稿时间：2022-06-01 修订日期：2023-02-01 |
| DOI： |
| 中文关键词: 清肺通络合剂 社区获得性肺炎 抗菌药物 肠道菌群 16S rRNA测序 |
| 英文关键词:Qingfeitongluo Mixture(QFTLM) Community-acquired pneumonia（CAP) Antibiotic Intestinal flora 16S rRNA sequencing |
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| 中文摘要: |
| 摘 要 目的 探讨中药清肺通络合剂（QFTLM）对气阴两虚兼痰热型社区获得性肺炎（CAP）患者肠道菌群多样性的影响。方法 采用前瞻性临床对照研究方法，根据患者采用的治疗方法不同，将23例气阴两虚兼痰热型CAP患者分为两组：予抗菌药物治疗组10例，予抗菌药物联合QFTLM治疗组13例。收集治疗前后患者粪便样本46份，利用PacBio测序平台进行16S rRNA测序，分析两组患者治疗前后样本中肠道菌群的组成、多样性和显著性差异物种。结果 （1）两组治疗前后肠道菌群的组成：在门水平为厚壁菌门、变形杆菌门、拟杆菌门、疣微菌门和放线菌门；在纲水平为梭菌纲、革兰阴性菌纲、芽孢杆菌纲、丹毒丝菌纲、拟杆菌纲、γ-变形杆菌纲、疣微菌纲和放线菌纲；在目水平为拟杆菌目、梭菌目、单胞菌目、肠杆菌目、乳杆菌目、丹毒丝菌目和颤螺菌目；在科水平为拟杆菌科、乳球菌科、肠杆菌科、韦荣球菌科、艾克曼菌科、毛螺菌科、喜热菌科、链球菌科、丹毒丝菌科和肠球菌科；在属水平为拟杆菌属、粪杆菌属、埃希氏菌属、罕见小球菌属、巨单胞菌属、艾克曼菌属、梭菌属、链球菌属和肠球菌属。（2）两组治疗前后梭菌纲的相对丰度抗菌药物组治疗前后为（0.48±0.24）比（0.17±0.14）（P<0.01）；抗菌药物联合QFTLM组治疗前后为（0.42±0.20）比（0.17±0.15）（P<0.05）。（3）两组治疗后α多样性较治疗前显著减少：抗菌药物组治疗前后Ace指数为（96.40±9.56）比（63.33±7.56）（P<0.05），PD_whole_tree指数为（6.43±0.56）比（4.63±0.55）（P<0.05）；抗菌药物联合QFTLM组治疗前后Shannon指数为（3.82±0.27）比（2.79±0.40）（P<0.05）。两组治疗前后β多样性差异不显著，主坐标分析显示第一主成分贡献率为30.74%。（4）两组显著性差异物种分析结果显示：抗菌药物组治疗前为厚壁菌门、梭菌纲、梭菌目和瘤胃球菌属，治疗后为链球菌科、链球菌属和唾液链球菌种；抗菌药物联合QFTLM组治疗前为梭菌纲、梭菌目、瘤胃球菌科和毛螺菌科，治疗后为肠球菌科、肠球菌属、鸟肠球菌种和多形拟杆菌种。结论 气阴两虚兼痰热型CAP患者经抗菌药物治疗，肠道菌群α多样性明显减少，显著性差异物种发生改变。QFTLM无法完全改变肠道菌群α多样性减少，但可以增加肠球菌和多形拟杆菌的相对丰度，改变显著性差异物种。 |
| 英文摘要: |
| ABSTRACT Objective To investigate the effect of QFTLM on diversity of intestinal flora in patients with CAP with deficiency of both qi and yin and phlegm-heat type. Methods 23 cases of CAP patients with deficiency of both qi and yin and phlegm-heat type were divided into two groups by prospective clinical controlled study according to different treatment :10 cases were treated with antibiotics, 13 cases were treated with antibiotics combined with QFTLM. 46 fecal samples were collected to analyze the composition, microbial diversity and significantly different species before and after treatment in two groups by 16S rRNA sequencing on PacBio platform. Results (1)The composition of microflora before and after treatment in two groups were Firmicutes, Proteobacteia, Bacteroidetes, Verrucomicrobia and Actinobacteria at phylum level; Clostridia,Negativicutes,Bacilli,Erysipelotrichale,Gammaproteobacteria,Verrucomicrobiae and Actinobacteria at class level; Bacteroidales, Clostridiales, Selenomonadales, Enterobacterales, Lactobacillales, Erysipelotrichaceae and Oscillospirales at order level; Bacteroidaceae, Ruminococcaceae, Enterobacteriaceae, Veillonellaceae, Akkermansiaceae, Lachnospiraceae, Caloramatoraceae, Streptococcaceae, Erysipelotrichaceae and Enterococcaceae at family level ; Bacteroides, Faecalibacterium, Escherichia, Megamonas, Subdoligranulum, Akkermansia, Clostridium, Streptococcus and Enterococcus at genus level. (2) The relative abundance of clostridia before and after treatment was statistically significant in two groups: (0.48±0.24)vs(0.17±0.14 )(P<0.01) in antibiotic group and (0.42±0.20)vs (0.17±0.15) (P<0.05)in combined treatment group. (3) The α diversity after treatment was significantly lower than that before treatment in two groups: Ace index was (96.40±9.56)vs (63.33±7.56)(P<0.05) and PD_whole_tree index was (6.43±0.56)vs(4.63±0.55)(P<0.05) in antibiotic group. Shannon index was (3.88±0.27)vs(2.79±0.40)(P<0.05) in combined treatment group.There was no significant difference in β diversity in two groups before and after treatment.The first principal component contribution rate of PCoA analysis was 30.74% . (4) The species of significant difference analysis showed that the antibiotic group was composed of Firmicutes, Clostridiales, Clostridium , Ruminococcaceae before treatment, and it was composed of streptococcaceae, Streptococcus, salivary Streptococcus after treatment.The combined treatment group was composed of Clostridia, Clostridiales, Ruminococcaceae, Lachnospiraceae before treatment, and it was composed of Enterococcaceae, Enterococcus, Enterococcus avium,Bacteroides thetaiotaomicron after treatment. Conclusion The α diversity of intestinal flora in CAP patients with deficiency of both qi and yin and phlegm-heat type were significantly decreased and the different species of intestinal flora were changed after antibiotic treatment. QFTLM could not completely change the decrease of α diversity, but could increase the relative abundance of enterobacteriaceae and Bacteroides thetaiotaomicron and change the significantly different species |
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