老年2型糖尿病患者肠道菌群多样性及其炎症因子与胰岛素抵抗的相关性研究

目的探讨老年2型糖尿病（T2DM）患者肠道菌群多样性及其炎症因子的变化与胰岛素抵抗的相关性。 方法选取80例老年T2DM患者作为T2DM组，另选取80例健康体检者作为对照组，检测两组患者肠道菌群拟杆菌、普雷沃氏菌、乳杆菌、双歧杆菌和肠杆菌数量。测定并计算两组患者的稳态模型胰岛素抵抗指数（HOMA-IR），同时比较两组患者的白细胞介素6（IL-6）、IL-10、IL-22、肿瘤坏死因子α（TNF-α）和干扰素γ（IFN-γ）水平。采用Pearson相关性分析老年T2DM患者肠道不同菌群与HOMA-IR相关性，肠道不同菌群与各炎症因子的相关性。 结果老年T2DM组的拟杆菌[（10.0 ± 0.3）logN/g vs.（8.1 ± 0.9）logN/g]和肠杆菌[（9.86 ± 0.27）logN/g vs.（7.05 ± 0.19）logN/g]的菌落数显著高于对照组（t = 3.162、3.016，P均< 0.05），普雷沃氏菌[（7.22 ± 0.27）logN/g vs.（9.35 ± 0.39）logN/g]、乳杆菌[（5.12 ± 0.25）logN/g vs.（7.67 ± 0.43）logN/g]和双歧杆菌[（7.2 ± 0.4）logN/g vs.（11.0 ± 0.5）logN/g]的菌落数显著低于对照组（t = 5.230、4.163、7.115，P均< 0.05）。T2DM组的HOMA-IR[（6.4 ± 0.8）vs.（3.1 ± 0.4）]、IL-6[（154 ± 15）ng/L vs.（81 ± 10）ng/L]、IL-22[（628 ± 36）ng/L vs.（106 ± 11）ng/L]、TNF-α[（208 ± 23）ng/L vs.（118 ± 11）ng/L]和IFN-γ[（136 ± 15）ng/L vs.（76 ± 13）ng/L]的水平显著高于对照组（t = 7.156、3.167、5.026、3.557、2.134，P均< 0.05），而IL-10[（127.7 ± 18.7）ng/L vs.（376.8 ± 1.8）ng/L]水平显著低于对照组（t = 2.272，P < 0.05）。相关性分析结果显示，普雷沃氏菌、肠杆菌与血浆HOMA-IR呈显著正相关（r =0.613、0.437，P均< 0.05），拟杆菌、乳杆菌和双歧杆菌与HOMA-IR呈显著负相关（r = -0.617、-0.575、-0.616，P均< 0.05）。拟杆菌、普雷沃氏菌、乳杆菌和双歧杆菌数量与IL-6（r = -0.617、-0.526、-0.575、-0.616，P均< 0.05）、IL-22（r = -0.636、-0.587、-0.621、-0.573，P均< 0.05）、TNF-α（r = -0.593、-0.633、-0.476、-0.539，P均< 0.05）和IFN-γ（r = -0.475、-0.538、-0.602、-0.573，P均< 0.05）水平呈显著负相关性，与IL-10呈显著正相关性（r = 0.535、0.623、0.459、0.506，P均< 0.05）；肠杆菌与IL-6、IL-22、TNF-α和IFN-γ水平呈显著正相关性（r = 0.437、0.599、0.576、0.518，P均< 0.05），与IL-10呈显著负相关性（r = -0.518，P < 0.05）。 结论老年T2DM患者肠道菌群与胰岛素抵抗具有相关性，推测其机制可能与炎症因子水平有关。

Correlation of intestinal flora diversity,inflammatory factors and insulin resistance in elderly patients with type 2 diabetes mellitus

ObjectiveTo investigate the correlation of intestinal flora diversity, inflammatory factors and insulin resistance in elderly patients with type 2 diabetes mellitus (T2DM). MethodsTotally 80 elderly patients with T2DM were selected as the T2DM group, and 80 healthy subjects were enrolled as the control group. The Bacteroides, Prevotella, Lactobacillus, Bifidobacterium and Enterobacteriaceae were detected, and homeostasis model assessment-insulin resistance (HOMA-IR) was calculated in the two groups. The interleukin 6 (IL-6), IL-10, IL-22, tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) were measured and compared between them. Pearson correlation analysis was used to analyze the relationship of different intestinal flora with HOMA-IR and inflammatory factors in elderly T2DM patients. ResultsCompared to the control group, the amount of Bacteroides [(10.0 ± 0.5) logN/g vs. (8.1 ± 0.9) logN/g] and Enterobacteriaceae [(9.86 ± 0.27) logN/g vs. (7.05 ± 0.19) logN/g] was significantly higher (t = 3.162, 3.016; both P < 0.05), and the amount of Prevotella [(7.22 ± 0.27) logN/g vs. (9.35 ± 0.39) logN/g], Lactobacillus [(5.12 ± 0.25) logN/g vs. (7.67 ± 0.43) logN/g] and Bifidobacterium [(7.2 ± 0.4) logN/g vs. (11.0 ± 0.5) logN/g] was significantly lower in the T2DM group (t = 5.230, 4.163, 7.115; all P < 0.05). The levels of HOMA-IR [(6.4 ± 0.8) vs. (3.1 ± 0.4)], IL-6 [(154 ± 15) ng/L vs. (81 ± 10) ng/L], IL-22 [(628 ± 36) ng/L vs. (106 ± 11) ng/L], TNF-α [(208 ± 23) ng/L vs. (118 ± 11) ng/L] and IFN-γ [(136 ± 15) ng/L vs. (76 ± 13) ng/L] were significantly higher (t = 7.156, 3.167, 5.026, 3.557, 2.134; all P < 0.05), and the IL-10 level [(127.7 ± 18.7) ng/L vs. (376.8 ± 1.8) ng/L] was significantly lower in the T2DM group than in the control group (t = 2.272, P < 0.05). The correlation analysis showed that there were positive correlations between Prevotella, Enterobacteriaceae and HOMA-IR (r = 0.613, 0.437; both P < 0.05), and negative correlations between Bacteroides, Lacto-bacillus, Bifidobacterium and HOMA-IR (r = -0.617, -0.526, -0.575, -0.616; all P < 0.05). The Bacteroides, Prevotella, Lactobacillus and Bifidobacterium were negatively correlated to IL-6 (r = -0.617, -0.526, -0.575, -0.616; all P < 0.05), IL-22 (r = -0.636, -0.587, -0.621, -0.573; all P < 0.05), TNF-α (r = -0.593, -0.633, -0.476, -0.539; all P < 0.05) and IFN-γ (r = -0.475, -0.538, -0.602, -0.573; all P < 0.05), and positively correlated to IL-10 (r = 0.535, 0.623, 0.459, 0.506; all P < 0.05). Enterobacteriaceae was positively correlated to IL-6, IL-22, TNF-α and IFN-γ (r = 0.437, 0.599, 0.576, 0.518; all P < 0.05), and negatively correlated to IL-10 (r = -0.518, P < 0.05). ConclusionThe association between intestinal flora and insulin resistance in elderly T2DM patients suggests that its mechanism may be related to the level of inflammatory factors.