桥本甲状腺炎患者肠道菌群分布特征及其与甲状腺功能的关系研究OACSTPCD

Objective To explore the intestinal flora distribution characteristics in patients with Hashimoto's thyroiditis(HT)and analyze the correlation between intestinal flora changes and HT and the predictive value on the occurrence of HT,so as to provide reference for clinical diagnosis and treatment of HT.Methods A total of 120 patients with HT admitted to Qinhuangdao Traditional Chinese Medicine Hospital from June 2022 to June 2023 were included in observation group,and 30 healthy physical examination subjects during the same period were enrolled as control group.Both groups performed intestinal flora detection and thyroid function detection.The α diversity and the relative abundance of intestinal flora at phylum level were compared between the two groups and among HT patients with different thyroid functions,and the correlation between α diversity of intestinal flora and relative abundance of intestinal flora at phylum level,serum levels of anti-thyroglobulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)and thyroid function was analyzed by spearman correlation analysis.Receiver operating characteristic(ROC)curve was used to analyze the predictive efficiency of α diversity and relative abundance of intestinal flora at phylum level on HT.Results Compared with control group,the intestinal flora α diversity indexes of shannon-wiener diversity index(shannon)and simpson diversity index(simpson)were lower in observation group[4.66±0.61 vs 5.21±0.46,0.89±0.06 vs 0.93±0.07],and the differences were statistically significant(r=4.617,3.156,P＜0.05).The relative abundance of Bacteroidetes in observation group was lower than that in control group(52.31％±2.02％vs 58.59％±2.11％),while the relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were higher than those in control group(37.15％±2.43％vs 33.46％±2.56％,3.36％±0.26％vs 2.79％±0.19％,1.02％±0.09％vs 0.65％±0.11％,1.01％±0.12％vs 0.57％±0.13％,0.82％±0.11％vs 0.41％±0.09％),and the differences were statistically significant(t=15.096,7.360,11.267,19.231,17.665,18.882,all P＜0.001).The levels of serum TgAb(169.12±10.23 IU/ml vs 18.59±1.78 IU/ml)and TPOAb(56.43±12.11 IU/ml vs 2.51±0.57 IU/ml)in observation group were higher compared with those in control group,and the differences were statistically significant(t=80.097,24.319,all P＜0.001).Among 120 HT patients in this study,there were 89 cases with normal thyroid function and 31 cases with abnormal thyroid function.The intestinal flora α diversity indexes of shannon(4.49±0.64 vs 4.83±0.58),and simpson(0.87±0.07 vs 0.91±0.05)in patients with abnormal thyroid function were lower than those in normal patients,and the differences were statistically significant(t=2.736,3.439,all P＜0.05).The relative abundance of Bacteroides was lower(49.10％±1.99％vs 55.52％±2.05％),while the relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were higher than those in normal people(38.87％±2.60％vs 35.43％±2.26％,3.60％±0.26％vs 3.12％±0.19％,1.15％±0.09％vs 0.89％±0.11％,1.16％±0.13％vs 0.86％±0.11％,0.97％±0.13％vs 0.67％±0.09％)],and the differences were statistically significant(t=15.128,7.016,9.849,14.576,12.464,14.148,all P＜0.001).Spearman correlation analysis showed that the intestinal flora α diversity indexes(shannon and simpson)and relative abundance of Bacteroides in patients with HT were negatively correlated with serum TgAb and TPOAb levels(r=-0.436,-0.427,-0.402;-0.419,-0.456,-0.416,all P＜0.001),but were positively correlated with thyroid function(r=0.401,0.409,0.487,all P＜0.001).The relative abundances of Firmicutes,Proteobacteria,Fusobacteria,Actinobacteria and Verrucomicrobia were positively correlated with serum TgAb and TPOAb levels(r=0.411,0.441,0.447,0.421,0.447;0.425,0.415,0.438,0.402,0.469,all P＜0.001),but were negatively correlated with thyroid function(r=-0.412,-0.417,-0.475,-0.463,-0.471,all P＜0.001).ROC curve analysis revealed that the best cut-off value,the area under curve(AUC),sensitivity,specificity,95％confidence interval(95％CI)and Youden index in shannon,simpson,combined detection of simpson and shannon,and the combined detection of relative abundance of intestinal bacteria at phylum level for predicting HT were 4.677,0.749,49.17％,96.67％,95％CI(0.672～0.816)and 0.458;0.940,0.644,80.00％,53.33％,95％CI(0.562～0.721)and 0.333;0.752,85.83％,50.00％,95％CI(0.664～0.810)and 0.462;0.743,96.67％,46.67％,95％CI(0.665～0.811)and 0.548,respectively Conclusion HT had intestinal flora imbalance which was related to thyroid cell destruction and thyroid dysfunction in patients with HT.Intestinal flora detection has predictive efficiency on HT.