肾草酸钙结石湿热体质、痰湿体质与肠道菌群相关性的临床研究OACSTPCD
Clinical study on the relationship between kidney calcium oxalate stones,damp-heat constitution,phlegm-dampness constitution and intestinal flora
目的 探讨肾草酸钙结石湿热体质、痰湿体质与肠道菌群间相关性.方法 将 60 例肾草酸钙结石复发患者,分为湿热体质30 例,痰湿体质 30 例.观察肠道菌群高通量测序结果;24 h尿液草酸、枸橼酸含量.结果 2 组肠道菌群高通量测序结果显示,2 组样本共得到 3 790 个操作分类单元(OTUs),其中,湿热体质组和痰湿体质组OTUs数目分别为 2 394 个和 2 289 个.采用线性判别式分析差异菌群结果显示,湿热体质组菌群以丙型变形菌纲、肠杆菌科、肠杆菌目、变形菌门为主要特征差异细菌菌类,痰湿体质组菌群以疣微菌科、氏菌属、粪芽孢菌属、甲型变形菌纲、柔嫩梭菌为主要特征差异细菌菌类.通过OTUs代表性序列的物种分类学分析,与湿热体质组相比,痰湿体质组在门、纲、目分类水平上菌群丰度呈升高的分别为变形菌门、丙型变形菌纲和肠杆菌目;在科水平上,具有丰度增高的肠杆菌科和消化链球菌科,以及丰度显著减低的疣微菌科;在属水平上,具有丰度增高的埃希氏杆菌属;在种水平上,具有丰度降低的单形拟杆菌.2 组肠道菌群菌种丰度比较显示,痰湿体质组中变形菌门、肠杆菌目丰度高于湿热体质组,厚壁菌门、疣微菌科丰度低于湿热体质组,差异均有统计学意义(P<0.05).2 组治疗前,湿热体质组 24 h尿液中草酸和枸橼酸水平均高于痰湿体质组,差异均具有统计学意义(P<0.05).湿热体质组治疗后草酸含量较本组治疗前降低,差异具有统计学意义(P<0.05);痰湿体质组治疗后草酸含量较本组治疗前降低,枸橼酸含量较本组治疗前升高,差异均具有统计学意义(P<0.05).结论 肾草酸钙结石湿热体质、痰湿体质与肠道菌群间有一定相关性,中医辨证治疗可改善肾草酸钙结石高危代谢因素.
Objective To investigate the relationship between kidney calcium oxalate stones,damp-heat constitution,phlegm-dampness constitution,and intestinal flora.Methods 60 patients with recurrent renal calcium oxalate stones were divided into two groups:30 patients with a damp-heat constitution and 30 patients with a phlegm-dampness constitution.High-throughput sequencing of intestinal flora was performed,and 24-hour urine oxalic acid and citric acid levels were measured.Results The high-throughput sequencing of intestinal flora identified 3,790 operational taxonomic units(OTUs)across both groups.The damp-heat group had 2,394 OTUs,while the phlegm-dampness group had 2,289.Linear discriminant analysis revealed that the damp-heat group's flora was characterized by Proteobacteria C,Enterobacteriaceae,Enterobacteriales,and Proteobacteria,whereas the phlegm-dampness group's flora was characterized by Verrucomicrobiaceae,Bacteroides,Coprococcus,Proteobacteria A,and Clostridium teniculum.Comparative taxonomic analysis of OTU representative sequences showed increased abundance in the phlegm-dampness group at the phylum,class,and order levels,particularly Proteobacteria,Proteobacteria C,and Enterobacteriales.At the family level,Enterobacteriaceae and Peptostreptococcaceae were more abundant,while Verrucomicrobiaceae were significantly less abundant in the phlegm-dampness group.Genus-level analysis showed increased Escherichia and decreased Bacteroides abundance.Comparison of intestinal flora abundance indicated higher levels of Proteobacteria and Enterobacteriales in the phlegm-dampness group and higher levels of Firmicutes and Verrucomicrobiaceae in the damp-heat group,with statistically significant differences(P<0.05).Before treatment,24-hour urine oxalic acid and citric acid levels were higher in the damp-heat group than in the phlegm-dampness group(P<0.05).Post-treatment,the damp-heat group showed a significant reduction in oxalic acid levels(P<0.05),while the phlegm-dampness group showed a significant reduction in oxalic acid levels and an increase in citric acid levels(P<0.05).Conclusion There is a correlation between damp-heat constitution,phlegm-dampness constitution,and intestinal flora in patients with kidney calcium oxalate stones.Traditional Chinese Medicine(TCM)syndrome differentiation treatment can improve high-risk metabolic factors associated with kidney calcium oxalate stones.
金振华;张继康;陈凯华;许坤;孙梦伟;卢子杰
南京中医药大学附属医院/江苏省中医院 南京 210029南京中医药大学第二附属医院
中医学
肾草酸钙结石湿热体质痰湿体质肠道菌群草酸枸橼酸
renal calcium oxalate calculusdampness-heat constitutionphlegm-dampness constitutionintestinal floraoxalic acidcitric acid
《现代中医临床》 2024 (004)
14-18 / 5
江苏省中医药管理局(No.RC201902)
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