艾滋病患者肠道微生态初步研究

发布时间：2018-04-27 06:25

本文选题：艾滋病 + 肠道微生态　；参考：《广州医科大学》2014年硕士论文

【摘要】：艾滋病是一种由人类免疫缺陷病毒引起的免疫缺陷性疾病。我国HIV感染有如下特点：整体疫情依然呈上升趋势，但增速减缓；HIV感染者发病进入高发期，死亡人数增加；十二五规划提出，将提高艾滋病病毒感染者和艾滋病病人的生活质量做为一项目标。艾滋病作为一种无法治愈的疾病，影响其生存质量的主要原因是各种并发症的发生。近些年研究发现，肠道菌群与人体健康有着密切的关系。肠道微生态失衡是导致免疫低下患者内源性感染发生的主要原因之一，所以研究艾滋病患者肠道微生态的变化具有重大意义。研究目的: 本研究旨对正常健康成人与艾滋病非腹泻患者及艾滋病腹泻患者粪便中肠道菌群失调程度进行比较，及5种代表菌进行定量分析，比较其肠道菌群失调的差异，研究艾滋病患者肠道微生态的变化，并研究其与CD4+T/CD8+T淋巴细胞数值、血液培养阳性及消化道症状等的关系。希望可以为临床医生对艾滋病患者肠道微生态状况了解提供理论依据。研究方法： 59例艾滋病非腹泻患者作为实验组，30例健康成人作为对照组，22例艾滋病腹泻患者作为腹泻组，革兰氏染色涂片观察进行肠道菌群失调分度，选择肠道菌群中具有代表性的5种菌（双歧杆菌、肠球菌、肠杆菌、乳酸杆菌、真菌）进行细菌培养及计数，并计算反映肠道定值抗力的指标B/E值。研究结果： 1.肠道菌群失调程度比较：三组两两比较差异均有统计学意（P0.001），正常组的肠道菌群分度以正常的居多（86.7%），实验组的以Ⅰ度（66.1%）的居多，腹泻组也以Ⅰ度（63.6%）的居多，但Ⅱ度的比例(31.6%)明显比正常组(0%)和实验组（5.1%）多。 2.肠道菌落比较：三组之间的粪便细菌数量有差异，其中(1)肠杆菌：正常人组的肠杆菌多于腹泻组（P=0.015），实验组的肠杆菌多于腹泻组（P=0.011），正常人组与实验组比较差异无统计学意义(P=0.487)；(2)肠球菌：实验组的肠球菌多于正常人组（P0.001），腹泻组的肠球菌多于正常组（P=0.016），实验组与腹泻组比较差异无统计学意义（P=0.664）；(3)双歧杆菌：实验组的双歧杆菌多于腹泻组（P=0.002）。正常组与实验组及腹泻组比较差异均无统计学意义（P值分别为0.323、0.344）。（4）真菌：实验组的真菌多于正常人组（P=0.002），，腹泻组的真菌多于正常组（P0.001），实验组与腹泻组比较差异无统计学意义（P=0.441）。（5）乳酸杆菌及B/E值：三组的乳酸杆菌及B/E值比较差异无统计学意义（P0.05）。 3.五种代表菌数量、B/E值、肠道菌群失调分度之间的相关分析：肠道菌群分度与肠杆菌（P=0.016）、乳酸杆菌（P0.001）呈负相关，与肠球菌(P0.001)、真菌(P0.001)呈正相关；肠杆菌与B/E值（P0.001）、肠道菌群分度(P=0.016)呈负相关,与双歧杆菌（P=0.026）、乳酸杆菌（P0.001）呈正相关；肠球菌与肠道菌群分度（P0.001）及双歧杆菌（P0.001）呈正相关；双歧杆菌与肠杆菌（P=0.026）、肠球菌（P0.001）、乳酸杆菌（P0.001）、B/E值（P0.001）均呈正相关；乳酸杆菌与肠杆菌（P0.001）、双歧杆菌（P0.001）呈正相关，与肠道菌群分度（P0.001）呈负相关；真菌与肠道菌群分度（P0.001）呈正相关。 4.五种代表菌数量、肠道菌群失调分度及B/E值与淋巴细胞的相关分析： CD4+T淋巴细胞与肠球菌（P=0.008）、真菌（P=0.044）、肠道菌群分度(P0.001)均呈负相关；CD8+T淋巴细胞与乳酸杆菌(P=0.001)呈正相关，与真菌(P=0.001)、肠道菌群分度(P=0.006)呈负相关，与其他菌及B/E的相关无统计学意义。 5.五种代表菌数量、肠道菌群失调分度及B/E值与血液培养阳性的相关分析：血液培养结果阳性与双歧杆菌（P=0.019）、B/E值(P=0.010)呈负相关；其中血液培养中马尔尼菲青霉菌病与B/E值呈负相关(P=0.036)； 6.五种代表菌数量、肠道菌群失调分度及B/E值与消化道症状的相关分析：腹痛腹泻病程及平均每天次数与肠杆菌、双歧杆菌、乳酸杆菌呈负相关(P0.05)，与肠道菌群失调分度呈正相关(P0.05)；结论：艾滋病患者与正常人肠道微生态有差异，提示其肠道紊乱，且与CD4+TCD8+T淋巴细胞数值、血液培养阳性及患者的消化道症状均存在相关性。
[Abstract]:AIDS is an immunodeficiency disease caused by the human immunodeficiency virus. The HIV infection in China has the following characteristics: the overall epidemic is still on the rise, but the growth rate slows down; the incidence of HIV infected people is high and the death toll increases; the plan proposed in 12th Five-Year will improve the lives of HIV infected people and AIDS patients. Quality is a goal. As an untreatable disease, the main cause of the quality of life is the occurrence of various complications. In recent years, studies have found that intestinal microflora is closely related to human health. Intestinal microecological imbalance is one of the main causes of endogenous infection in immunocompromised patients. It is of great significance to study the changes of intestinal microecology in AIDS patients.
The purpose of the study is:
The purpose of this study was to compare the intestinal flora imbalance between normal healthy adults and non diarrhea patients with AIDS and AIDS diarrhea, and the quantitative analysis of 5 representative bacteria, compare the difference of intestinal flora imbalance, study the changes of intestinal microecology of AIDS patients, and study the value of CD4+T/CD8+T lymphocyte and blood. We hope to provide a theoretical basis for clinicians to understand the intestinal microflora of AIDS patients.
Research methods:
59 cases of non diarrhea patients with AIDS were used as experimental group, 30 healthy adults as control group, 22 cases of AIDS and diarrhea as diarrhea group and Gram stain smear to observe intestinal flora imbalance, and select 5 representative bacteria (bifidobacteria, Enterococcus, enterobacter, lactobacilli, fungi) in intestinal microflora. Count and calculate the B/E value reflecting the resistance value of the intestinal tract.
The results of the study:
1. the degree of maladjustment of intestinal flora was compared.
The differences of the three groups were statistically significant (P0.001). The intestinal microflora in the normal group was more than normal (86.7%), the experimental group was mostly I (66.1%), and the diarrhea group was mostly in the degree of I (63.6%), but the proportion of the second degree (31.6%) was significantly higher than that of the normal group (0%) and the experimental group (5.1%).
2. comparison of intestinal colonies:
The number of fecal bacteria between the three groups was different, including (1) Enterobacteriaceae: intestinal bacilli in the normal group was more than the diarrhea group (P=0.015), the Enterobacteriaceae in the experimental group was more than the diarrhea group (P=0.011), and there was no significant difference between the normal group and the experimental group (P=0.487); (2) the Enterococcus in the experimental group was more than the normal group (P0.001) and the diarrhea group. There were more Enterococcus than in the normal group (P=0.016), and there was no significant difference between the experimental group and the diarrhea group (P=0.664). (3) bifidobacteria: bifidobacteria in the experimental group was more than the diarrhea group (P=0.002). There was no significant difference between the normal group and the experimental group and the diarrhea group (P value 0.323,0.344). (4) the fungi in the experimental group were more than the positive. The normal group (P=0.002), the fungi in the diarrhea group were more than the normal group (P0.001). There was no significant difference between the experimental group and the diarrhea group (P=0.441). (5) the lactic acid bacilli and the B/E value: there was no statistical difference between the three groups of lactobacilli and B/E (P0.05).
3. correlation analysis of the number of five representative bacteria, B/E value and imbalance of intestinal flora.
Intestinal microflora was negatively correlated with Enterobacteriaceae (P=0.016), Lactobacillus (P0.001), positive correlation with Enterococcus (P0.001) and fungi (P0.001); Enterobacteriaceae was negatively correlated with B/E (P0.001), intestinal flora diversity (P=0.016), positive correlation with Bifidobacterium (P=0.026) and Lactobacillus (P0.001); Enterococcus and intestinal microflora (P0.001) and bifidus Bacilli (P0.001) was positively correlated; Bifidobacterium was positively correlated with Enterobacteriaceae (P=0.026), Enterococcus (P0.001), Lactobacillus (P0.001) and B/E (P0.001); Lactobacillus was positively correlated with Enterobacteriaceae (P0.001), Bifidobacterium (P0.001) and negatively correlated with intestinal microflora (P0.001); fungi and intestinal microflora (P0.001) were positively correlated.
4. the correlation between the number of five representative bacteria, the imbalance of intestinal flora and the B/E value and lymphocytes.
CD4+T lymphocytes were negatively correlated with Enterococcus (P=0.008), fungi (P=0.044) and intestinal microflora (P0.001), CD8+T lymphocytes were positively correlated with Lactobacillus (P=0.001), and negatively correlated with fungi (P=0.001) and intestinal microflora fraction (P=0.006), and had no statistical significance with other bacteria and B/E.
5. the correlation between the number of five representative bacteria, the imbalance of intestinal flora, the B/E value and the positive blood culture:
The results of positive blood culture were negatively correlated with P=0.019 and B/E value (P=0.010), and in the blood culture, penicilliosis marneffia was negatively correlated with the value of B/E (P=0.036).
6. the correlation between the number of five representative bacteria, the imbalance of intestinal flora, B/E and gastrointestinal symptoms:
The duration of abdominal pain, diarrhea and the average daily number were negatively correlated with Enterobacteriaceae, bifidobacteria and Lactobacillus (P0.05), and positively correlated with the imbalance of intestinal flora (P0.05).
Conclusion: the intestinal microecology of AIDS patients and normal people is different, indicating the intestinal disorder, and the correlation with the CD4+TCD8+T lymphocyte value, the positive blood culture and the symptoms of the digestive tract of the patients.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

【参考文献】