老年骨骼肌量减少和肠道微生态变化

发布时间：2018-09-01 19:50

【摘要】：目的：探讨老年骨骼肌量减少者的肠道菌群结构特点,以及老年骨骼肌量减少和肠道微生态变化的相关性。方法：本研究是横断面研究,从浙江大学附属第一医院老年医学科电子病历数据库收集资料,研究对象是年龄大于或等于60岁的老年患者,即2013年6月1日至2015年12月31日期间在我科住院的老年患者,住院期间同时接受了骨骼肌双能X线吸收检测(Dual Energy X-ray Absorptiometry, DEXA)和粪便菌群检查。DEXA测量与粪便标本采集的时间间隔小于三个月。研究对象排除了所有急性疾病、重症、昏迷、或疾病终末期患者。采集患者粪便标本前一个月内未给予抗生素、化疗、放疗、免疫抑制、益生菌或激素等影响肠道微生态结构的相关治疗。根据患者的骨骼肌质量是否减少分为2组：骨骼肌减少组与非骨骼肌减少组。老年骨骼肌量减少的诊断标准是DEXA测量指定骨骼肌质量指数(skeletal mass index, SMI):男性小于7 kg/m2、女性小于5.4kg/m2。以定量PCR检测患者的肠道微生态菌群丰度,以血红蛋白水平和白蛋白水代表患者营养状态,以C反应蛋白水平代表患者的炎症情况。结果：共59例患者纳入本研究,依据SMI水平,共有48例老年患者的骨骼肌质量减少。年龄(平均年龄84.2岁)、体重指数(平均BMI评分=23.9kg/m2)、血红蛋白水平(平均值123g/L)、白蛋白水平(平均值39.6mg/L)和C反应蛋白水平(平均值2.3mg/L)在骨骼肌减少组与非骨骼肌减少组之间无统计学差异。两组间患者的肠道菌群的丰度有统计差异,肠杆菌科细菌丰度与患者的骨骼肌质量指数显著负相关(相关系数=-0.31,p值=0.03),骨骼肌减少组的肠杆菌丰度比非骨骼肌减少组多7倍。此外,在骨骼肌减少组,致病菌肠杆菌的丰度与抗炎细菌群如普拉梭菌群、梭菌群Ⅳ、乳酸菌、双歧杆菌的丰度呈正相关,与其它致病菌如梭菌cluster Ⅰ呈正相关。而在非骨骼肌减少组,致病肠杆菌的丰度与抗炎菌普氏菌的丰度呈负相关(相关系数=-0.7 p值=0.03)。此外,在骨骼肌减少组患者中,血红蛋白水平与致病菌的丰度呈负相关。相反,在非骨骼肌减少组,血红蛋白水平与抗炎菌普拉梭菌及乳杆菌的丰度呈正相关。结论：与以往的研究结果类似,中国人群中的老年骨骼肌肌量减少患者具有肠道菌群失调,表现为致病性肠杆菌群的增加,同时此菌群的丰度与SMI值有负相关性。并且本研究最新发现患者的血红蛋白水平与肠道菌群失调有相关性。今后通过进一步纵向研究,可以更明确老年骨骼肌量减少与肠道微生态改变的因果关系。
[Abstract]:Aim: to investigate the characteristics of intestinal microflora in elderly patients with decreased skeletal muscle volume and the correlation between the decrease of skeletal muscle volume and the changes of intestinal microecology. Methods: this study was a cross-sectional study. The data were collected from the electronic medical records database of geriatrics department of the first affiliated Hospital of Zhejiang University. The subjects of the study were elderly patients aged over or equal to 60 years old. From 1 June 2013 to 31 December 2015, the elderly patients who were hospitalized in the Department from 1 June 2013 to 31 December 2015, The time interval between (Dual Energy X-ray Absorptiometry, DEXA) and faecal microflora was less than three months. The subjects excluded all patients with acute, severe, coma, or end-stage disease. No antibiotics, chemotherapy, radiotherapy, immunosuppression, probiotics or hormones were given to the patients within one month before the collection of stool samples. The patients were divided into two groups according to the reduction of skeletal muscle mass: skeletal muscle reduction group and non-skeletal muscle reduction group. The diagnostic criteria for skeletal muscle loss in the elderly were DEXA measurements of the specific skeletal muscle mass index (skeletal mass index, SMI): male less than 7 kg/m2, and female less than 5.4 kg / m2. Quantitative PCR was used to detect the intestinal microflora abundance, hemoglobin level and albumin water were used to represent the nutritional status of the patients, and C-reactive protein level was used to represent the inflammatory status of the patients. Results: a total of 59 patients were included in this study. According to the SMI level, 48 elderly patients had decreased skeletal muscle mass. Age (mean age 84.2 years), body mass index (BMI score: 23.9kg / m ~ 2), hemoglobin (mean 123g/L), albumin (mean 39.6mg/L) and C-reactive protein (2.3mg/L) in skeletal and non-skeletal muscle reduction groups There was no statistical difference between the two groups. There was statistical difference in the abundance of intestinal flora between the two groups. There was a significant negative correlation between the bacterial abundance of Enterobacteriaceae and the skeletal muscle mass index (correlation coefficient was 0.03). The intestinal bacillus abundance in the group of skeletal muscle reduction was 7 times higher than that in the group of non-skeletal muscle reduction. In addition, there was a positive correlation between the abundance of Enterobacter spp. And the abundance of anti-inflammatory bacteria such as Clostridium praziae, Clostridium clostridium 鈪，

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