初诊肺结核患者肠道菌群改变及其与耐多药的临床关系分析-东南大学学报医学版

初诊肺结核患者肠道菌群改变及其与耐多药的临床关系分析

单位：三门峡市中心医院医学检验科, 河南三门峡 472000

分类号：R521

出版年·卷·期（页码）：2024·43·第三期（431-438）

摘要：

目的:观察初诊肺结核患者肠道菌群改变,并分析其与耐多药的临床关系。方法:选取2021年6月至2023年5月本院收治的初诊肺结核患者347例,纳入肺结核组。另选取同期于本院体检的健康受试者347例,纳入健康组。比较两组肠道菌群属水平的相对丰度及肠道菌群Observed species指数、Shannon指数;肺结核组患者治疗2个月后,根据结核分枝杆菌(MTB)是否耐多药将肺结核组分为耐多药组、非耐多药组;比较耐多药组、非耐多药组一般资料及肠道菌群属水平的相对丰度;采用Logistic回归模型分析初诊肺结核患者耐多药的影响因素。结果:与健康组比较,肺结核组丁酸单胞菌属、类杆菌属、乳杆菌属、双歧杆菌属、布劳特菌属、梭状芽孢杆菌属的相对丰度及Observed species指数、Shannon指数降低(P＜0.05),肠球菌属、粪球菌属、多尔菌属、志贺菌属、小杆菌属、韦荣球菌属、瘤胃球菌属的相对丰度升高(P＜0.05);初诊肺结核患者耐多药率23.08%;与非耐多药组比较,耐多药组双歧杆菌属的相对丰度及Observed species指数、Shannon指数降低(P＜0.05);Logistic回归模型分析显示,初中及以下文化程度(OR=2.678,95%CI:1.309~5.476)、慢性阻塞性肺疾病(COPD)(OR=3.931,95%CI:1.514~10.212)、结核病接触史(OR=2.494,95%CI:1.364~4.562)、肺结核空洞病灶数量(OR=2.776,95%CI:1.872~4.116)、治疗过程中断(OR=2.450,95%CI:1.306~4.596)、双歧杆菌属相对丰度(OR=0.393,95%CI:0.268~0.576)和Shannon指数(OR=0.463,95%CI:0.302~0.712)是初诊肺结核患者耐多药的影响因素(P＜0.05)。结论:初诊肺结核患者肠道菌群平衡失调,初中及以下文化程度、COPD、结核病接触史、肺结核空洞病灶数量、治疗过程中断是其耐多药的危险因素,双歧杆菌属相对丰度、Shannon指数是其保护因素。

Objective: To observe the changes in intestinal flora of newly diagnosed pulmonary tuberculosis patients and analyze their clinical relationship with multidrug resistance. Methods: A total of 347 newly diagnosed pulmonary tuberculosis patients admitted to our hospital from June 2021 to May 2023 were enrolled in the tuberculosis group. Another 347 healthy subjects who underwent physical examination in our hospital during the same period were enrolled in the healthy group. The relative abundance, Observed species indexes and Shannon indexes of the intestinal flora at the genus level were compared between the two groups. Two months after treatment, according to whether mycobacterium tuberculosis(MTB) was multidrug-resistant, the tuberculosis group was divided into multidrug-resistant group and non-multidrug-resistant group. The general data, relative abundance of the intestinal flora at the genus level were compared between the multidrug-resistant group and the non-multidrug-resistant group. Logistic regression model was used to analyze the influencing factors of multidrug resistance in newly diagnosed pulmonary tuberculosis patients. Results: Compared with the healthy group, the relative abundance of butyricomonas, bacaeroides, lactobacillus, bifidobacterium, blautia, and clostridium, and the Observed species index and Shannon index in the tuberculosis group were decreased(P＜0.05), the relative abundance of enterococcus, coprococcus, dorella, shigella, microbacterium, veillonococcus, ruminococcus were increased(P＜0.05). The multidrug resistance rate of newly diagnosed pulmonary tuberculosis patients was 23.08%. Compared with the non-multidrug-resistant group, the relative abundance of bifidobacterium, the Observed species index and Shannon index decreased in the multidrug-resistant group(P＜0.05). Logistic regression model analysis showed that primary and secondary education level(OR=2.678, 95%CI:1.309-5.476), chronic obstructive pulmonary disease(COPD)(OR=3.931, 95%CI:1.514-10.212), history of tuberculosis exposure(OR=2.494, 95%CI:1.364-4.562), number of pulmonary tuberculosis cavity lesions(OR=2.776, 95%CI:1.872-4.116), treatment interruption(OR=2.450, 95%CI:1.306-4.596), relative abundance of bifidobacterium(OR=0.393, 95%CI:0.268-0.576) and Shannon index(OR=0.463, 95%CI:0.302-0.712) were influencing factors of multidrug resistance in newly diagnosed pulmonary tuberculosis patients(P＜0.05). Conclusion: Newly diagnosed pulmonary tuberculosis patients have intestinal flora imbalance. Primary and secondary education level, COPD, history of tuberculosis exposure, number of pulmonary tuberculosis cavity lesions, treatment interruption are risk factors for multidrug resistance, while relative abundance of bifidobacterium and Shannon index are protective factors.

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