脓毒症患者肠道菌群多样性和结构变化分析北大核心CSCD

目的探讨脓毒症患者发病过程中肠道菌群多样性和结构变化情况。方法对2015年11月至2016年3月期间于北京市多家三甲医院急诊科就诊并符合Sepsis3.0诊断标准的脓毒症患者25例和同时期30例非脓毒症患者的粪便样本进行检测,利用16S rRNA(16S ribosomal RNA)测序技术对肠道菌群进行测序,使用Uparse、Qiime、R及LEfSe软件等分析菌群多样性及其结构变化。结果脓毒症组和非脓毒症组患者在性别、年龄以及慢性基础疾病方面比较差异无统计学意义。两组在肠道菌群多样性方面比较差异无统计学意义(P>0.05)。两组在肠道菌群结构方面比较,差异有统计学意义(P<0.05),即脓毒症组患者肠道菌群中Negativicutes纲、Selenomonadales目、Veillonellaceae科、Lachnospiraceae科、Faecalibacterium属、Hafnia属、Lachnoclostridium属、Blautia属及Ruminococcus种的菌群丰度明显降低;而Bacilli纲、Coriobacteriia纲、Lactobacillales目、Coriobacteriales目、Clostridiaceae科、Coriobacteriaceae科、Clostridium_sensu_stricto属、Collinsella属及Collinsella_aerofaciens种的菌群丰度明显增加。结论脓毒症组与非脓毒症组患者相比较,肠道菌群多样性无改变;而脓毒症组的患者存在肠道菌群组成结构改变。     

重症监护室肺部感染患者肠道菌群特征分析

目的 探究重症监护室(ICU)肺部感染患者的肠道菌群特征,为肺部感染的危重症患者微生态靶向治疗提供借鉴。方法 收集2021年3-9月入住重庆高新区人民医院ICU的肺部感染患者粪便样本78例,ICU非肺部感染患者粪便样本22例,健康人群的粪便样本40例,采用16S rRNA测序技术对粪便菌群进行检测鉴定,通过生物信息学方法比较并分析ICU肺部感染患者肠道菌群结构特征。结果 ICU肺部感染患者的肠道微生物与健康人群相比,alpha多样性显著降低。ICU肺部感染患者肠道菌群以厚壁菌门、拟杆菌门、普雷沃菌属和拟杆菌属为主。处于极度失调(单一菌群丰度>50%)的ICU肺部感染患者的肠道菌群主要富集了普雷沃菌属、拟杆菌属、肠球菌和埃希菌等细菌。LEfSe分析提示,疣微菌科是ICU肺部感染患者肠道菌群中的标志性微生物。ICU肺部感染患者与健康人群相比,糖类和氨基酸代谢通路有所降低。另外,患者年龄结构、体质量指数、急性生理与慢性健康评分系统Ⅱ评分和住院时间与部分肠道菌群存在紧密联系。结论 ICU肺部感染患者与健康人群相比,肠道菌群多样性显著降低。ICU肺部感染患者中肠道菌群极度失调者,可能由于感...     

抑郁、焦虑状态人群的肠道菌群构成

目的:探讨抑郁、焦虑状态人群与健康人群肠道菌群组成的差异.方法:选择2017年5月至2018年4月复旦大学附属中山医院全科和心理门诊收治的237例就诊者,根据抑郁症筛查量表(patien health questionnare,PHQ-9)和广泛性焦虑障碍量表(generalized anxiexy disorde-7...     

基于16S rDNA检测的肠道菌群移植对慢传输型便秘的作用研究

目的 通过16S rDNA检测技术探讨慢传输型便秘(STC)患者肠道菌群特点以及肠道菌群移植(FMT)的作用。方法 选取30例STC患者作为STC组,给予2个疗程的规范化FMT治疗;选取同期20例健康成年人作为对照组。采用粪便16S rDNA测序技术对STC组和对照组肠道菌群进行比较,并对STC患者实施FMT前后的肠道菌群进行比较。结果 与对照组相比,STC组肠道菌群多样性降低,厚壁菌门相对丰度降低,而变形菌门和梭杆菌门相对丰度升高,差异均有统计学意义(P<0.05)。经FMT治疗后,功能性便秘患者菌群多样性升高,差异有统计学意义(P<0.05);在门水平上,STC患者实施FMT后拟杆菌门和梭状菌门相对丰度降低,而厚壁菌门和变形菌门相对丰度升高,差异有统计学意义(P<0.05)。STC组胃肠生活质量评分(GIQLI)、Wexner便秘评分均较治疗前下降,差异有统计学意义(P<0.05)。STC组抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、匹兹堡睡眠质量评分(PSQI)均较治疗前下降,差异有统计学意义(P<0.05)。结论 STC患者肠道菌群易发...     

不同病理类型阑尾炎儿童患者的肠道菌群多样性分析

目的 从分子生物学角度初步探究儿童患者不同阑尾炎病理类型的阑尾内容物菌群结构特征，为全面认识儿童阑尾炎病原菌提供新的视角。方法 依据手术组织病理分组，将收治的儿童阑尾炎患者分为单纯性阑尾炎组（n=6）和化脓性阑尾炎组（n=6），收集阑尾内容物DNA，对细菌rRNA基因序列V3-V4高变区扩增，用Illumina Nova测序，聚类分析两组菌群结构、丰度和多样性。结果 两组间Alpha多样性分析，差异有统计学意义（P <0.05），菌群丰度比较R=0.34，差异有统计学意义（P <0.05）。两组阑尾组织内容物在目、科、属、种水平有差异。在属水平单纯性阑尾炎组粪杆菌属、直肠真杆菌属居多，化脓性阑尾炎组嗜胆菌属居多。结论 通过对儿童阑尾炎患者不同病理类型阑尾内容物菌群的多样性分析，可发现单纯性阑尾炎和化脓性阑尾炎在菌群丰度和多样性上存在差异，为临床阑尾炎组织病原学研究提供新的思路。     

糖皮质激素治疗与中重度溃疡性结肠炎患者肠道菌群的相关性:单中心回顾性研究

  目的  分析接受及不接受糖皮质激素治疗的中重度溃疡性结肠炎(ulcerative colitis, UC)患者肠道菌群的差异, 并探讨肠道菌群对静脉糖皮质激素疗效的预测价值。  方法  回顾性分析2016年11月1日至2018年6月30日期间, 在北京协和医院消化内科门诊就诊或住院治疗的中重度UC患者临床资料。根据采集粪便样本时患者是否正在使用糖皮质激素, 将患者分为激素组和无激素组。无激素组患者入院后接受静脉激素、口服激素或免疫抑制剂治疗, 根据3 d后的疗效, 将入院后接受足量静脉激素治疗的患者分为治疗有效组和无效组。采用16S rRNA扩增子测序方法对粪便菌群测序分析, 采用香农指数评估肠道菌群α多样性, 采用Metastats分析比较不同组患者肠道菌群的物种构成差异。  结果  共35例符合入选和排除标准的中重度UC患者入选本研究, 无激素组20例, 激素组15例。无激素组中13例患者在采集粪便样本后接受静脉足量糖皮质激素治疗, 其中有效组8例, 无效组5例。激素组和无激素组患者的肠道菌群α多样性(香农指数:无激素组3.57±0.73, 激素组3.03±1.15, P=0.123)及物种组成无统计学差异。激素治疗有效组和无效组患者的肠道菌群α多样性亦无统计学差异(香农指数:有效组3.69±0.61, 无效组3.15±1.01, P=0.248), 但无效组的乳杆菌属(无效组0.0015±0.0000, 有效组0.0141±0.0002, P=0.010)和双歧杆菌属(无效组0.0178±0.0005, 有效组0.1716±0.0382, P=0.011)相对丰度显著低于有效组, 而志贺菌属(无效组0.4161±0.0750, 有效组0.1093±0.0173, P=0.008)和普雷沃氏菌属类群9(无效组0.0176±0.0004, 有效组0.0018±0.0000, P=0.044)的相对丰度则显著高于有效组。  结论  中重度UC患者肠道菌群的α多样性及物种组成可能与是否激素暴露无关, 但治疗前肠道菌群的物种组成可能是静脉激素疗效的潜在预测指标。     

61例腹腔手术后继发出血的临床分析:单中心回顾性研究

  目的  探讨腹腔手术后继发出血的原因和干预时机，以优化治疗方案。  方法  回顾性分析北京协和医院2013年1月至2018年12月腹腔手术后继发出血患者的临床资料，分析出血原因、治疗方案及预后情况。  结果  61例符合纳入和排除标准的腹腔手术后继发出血患者入选本研究，其中男性49例，女性12例，以胰十二指肠切除术患者最多(50.8%，31/61)，其次为肝脏手术(16.4%，10/61)和胃部手术(14.8%，9/61)。56例患者明确了出血原因，其中创面渗血和/或创面小动脉活动性出血24例(42.9%，24/56)，吻合口出血11例(19.6%，11/56)。出血后多数患者采取手术止血(65.6%，40/61)，成功率为87.5%；其次采取介入栓塞止血(24.6%，15/61)，成功率为26.7%，差异具有统计学意义(P＜0.01)。成功止血55例、死亡5例，1例患者放弃治疗。  结论  腹腔大手术后出血机率更高，手术止血效果可能优于介入栓塞止血。     

2型糖尿病患者肠道菌群两种分子指纹图谱分析研究

目的 利用重复共有序列(ERIC)和变性梯度凝胶电泳(DGGE)两种分子指纹图谱技术对2型糖尿病患者肠道菌群结构特征分析,探讨2型糖尿病与肠道菌群的相关性及对两种方法的评价。方法 收集8例健康人和7例2型糖尿病患者粪便样本,提取粪便菌群总DNA,采用ERIC-PCR和DGGE-PCR分子指纹图谱技术对两组人群肠道菌群结构分析,比较其多样性、相似性等生态学特征。结果 与健康对照组比较,2型糖尿病患者肠道菌群图谱条带和Shannon-Wiener多样性指数降低,但无统计学意义; 组内相似性降低差异有统计学意义(P＜0.05),菌群结构发生变化; 两种指纹图谱技术均能直观反映肠道菌群结构特征,ERIC方法简便,反映菌群多样性良好,但是实验影响因素较多,不可切胶测序; DGGE能较好反映菌群多样性、相似性等生态学特征,而且可选择条带切胶测序。结论 2型糖尿病患者肠道菌群组成结构发生改变,糖尿病的发生与肠道菌群有一定相关性; ERIC和DGGE是研究肠道菌群分辨效率高、重复性好的指纹图谱技术,DGGE并可进行切胶测序比对鉴定细菌,二者可结合使用。     

系统性硬化症与肠道菌群的关系

肠道菌群对人类健康和疾病有着深远影响。不仅肠道菌群能影响宿主免疫系统发育, 免疫系统本身也能改变肠道菌群。目前发现肠道菌群参与了多种自身免疫性疾病。研究发现, 系统性硬化症(systemic sclerosis, SSc)患者肠道菌群紊乱较常见, 胃肠道易受累, 且其中一些特定菌属与SSc患者胃肠道受累严重程度相关。本文对SSc患者肠道菌群变化特点、肠道菌群与SSc消化系统运动障碍和纤维化的关系以及治疗方案等方面进行系统阐述。     

Delirium in Newly Admitted Elderly Patients: A Prospective Study

The prevalence, associated conditions and outcome of deliriumwere studied in a consecutive series of 184 patients admittedwith acute illness to a department of health care of the elderly.Forty of these elderly subjects (22 per cent) met Diagnosticand Statistical Manual version 3 (revised) criteria for delirium.Screening for delirious patients using the abbreviated mentaltest on admission gave a high sensitivity (92 per cent). Theconditions most commonly associated with delirium were infectionand stroke. Onset of acute illness of less than 15 days, a reportedhistory of dementia or recent confusion, and presence of a definitesite of infection were much more likely in those with delirium.Serial use of the abbreviated mental test was a sensitive meansof distinguishing delirious from other patients and may be usefulin both the clinical and research setting. Delirious patientshad more serious pre-existing diseases than non-delirious patients.They had a higher number of admissions during the 2 years priorto the index admission, a higher mortality rate and a higherrate of transfer to long-stay care than other patients, butno difference in duration of admission. All acutely ill elderlypeople should undergo an abbreviated mental test on admission,and if abnormal, this should be repeated as it will aid detectionof delirium.     

英夫利西单克隆抗体治疗重症/难治性肠型白塞病的疗效分析:单中心回顾性研究

  目的  探讨英夫利西单克隆抗体(infliximab, IFX)治疗重症/难治性肠型白塞病(Behcet's disease, BD)的疗效及安全性。  方法  回顾性分析2012年9月至2018年11月, 北京协和医院风湿免疫科收治的因前期治疗无效而联合应用IFX的重症/难治性肠型BD患者临床资料, 包括临床表现、内镜下表现及病理、影像学检查、IFX联合治疗前后用药、治疗反应及预后。分析并比较联合用药前后症状改善及内镜下溃疡愈合情况, 采用配对t检验比较治疗前后红细胞沉降率、C反应蛋白、肠型BD疾病活动指数(disease activity index for intestinal BD, DAIBD)及糖皮质激素剂量的变化。  结果  12例BD患者纳入本研究, 其中男性10例, 女性2例, 平均年龄(29.5±10.5)岁, 均为活动性肠道受累BD, 确诊BD到开始IFX联合治疗的中位时间为27.0(4.3, 109.5)个月。12例患者均存在腹痛、消化道溃疡, 其中8例腹泻, 11例并发消化道出血, 4例肠梗阻, 3例肠穿孔。联合应用IFX后, 12例患者症状均得到改善, 溃疡渐愈合, 消化道出血好转, 1例穿孔患者同时行手术治疗, 1例患者缓解后出现结肠狭窄择期行梗阻肠段切除术。IFX联合治疗后, 红细胞沉降率[4.0(2.0, 6.8)mm/h比28.5(10.3, 52.3)mm/h, P＜0.01]、C反应蛋白[0.6(0.5, 1.7)mg/dl比26.8(9.1, 47.1)mg/dl, P＜0.01]、DAIBD(37.5±27.3比126.7±49.0, P＜0.01)和糖皮质激素剂量[13.8(1.9, 16.9)mg/d比40.0(16.3, 56.3)mg/d, P＜0.01]较治疗前显著下降。免疫抑制剂种类减少或不变。未观察到严重感染或药物不良反应。  结论  IFX联合糖皮质激素/免疫抑制剂对治疗严重/难治性肠BD安全、有效且耐受性良好。     

围手术期营养干预加速胃肠外科术后康复:单中心前瞻队列研究

  目的  探索围手术期营养干预的加速康复外科(enhanced recovery after surgery, ERAS)流程对胃肠外科手术患者的安全性和有效性。  方法  本研究为单中心前瞻性队列研究, 连续纳入2015年12月至2018年4月期间在北京协和医院基本外科行胃肠手术的患者, 在胃肠与营养代谢专业组接受手术治疗及ERAS管理的患者进入ERAS组, 在其他专业组接受传统围手术期管理者进入对照组。ERAS组围绕术前营养评估、口服或管饲营养补充、术后早期肠内营养等措施, 结合其他ERAS管理流程, 主要包括微创手术、全身麻醉或联合硬膜外阻滞等多模式镇痛、术后镇痛以非甾体类抗炎药为主; 对照组采用传统围手术期措施, 主要包括开腹或微创手术、全身麻醉、术后镇痛应用阿片类镇痛药物等。主要结局指标为术后住院天数, 次要结局指标包括住院总费用、术后并发症发生率、术后60 d内再入院率。  结果  共纳入204例患者, ERAS组和对照组各102例。ERAS组术后住院天数较对照组明显缩短[(7.2±4.5)d比(9.8±4.8)d, P < 0.001], 住院总费用亦显著降低[(41 125±18 593)元比(51 512±19 453)元, P < 0.001]。两组术后Clavien-Dindo分级Ⅱ级及以上并发症发生率和术后60 d内再入院率无统计学差异(9.8%比13.7%, 2.9%比2.0%, P均>0.05)。  结论  围手术期营养干预在胃肠外科中应用安全有效, 有利于患者术后实现加速康复。     

Outcomes After Intravenous Opioids in Emergency Patients: A Prospective Cohort Analysis

Objectives: Pain management continues to be suboptimal in emergency departments (EDs). Several studies have documented failures in the processes of care, such as whether opioid analgesics were given. The objectives of this study were to measure the outcomes following administration of intravenous (IV) opioids and to identify clinical factors that may predict poor analgesic outcomes in these patients. Methods: In this prospective cohort study, emergency patients were enrolled if they were prescribed IV morphine or hydromorphone (the most commonly used IV opioids in the study hospital) as their initial analgesic. Patients were surveyed at the time of opioid administration and 1 to 2 hours after the initial opioid dosage. They scored their pain using a verbal 0–10 pain scale. The following binary analgesic variables were primarily used to identify patients with poor analgesic outcomes: 1) a pain score reduction of less than 50%, 2) a postanalgesic pain score of 7 or greater (using the 0–10 numeric rating scale), and 3) the development of opioid-related side effects. Logistic regression analyses were used to study the effects of demographic, clinical, and treatment covariates on the outcome variables. Results: A total of 2,414 were approached for enrollment, of whom 1,312 were ineligible (658 were identified more than 2 hours after IV opioid was administered and 341 received another analgesic before or with the IV opioid) and 369 declined to consent. A total of 691 patients with a median baseline pain score of 9 were included in the final analyses. Following treatment, 57% of the cohort failed to achieve a 50% pain score reduction, 36% had a pain score of 7 or greater, 48% wanted additional analgesics, and 23% developed opioid-related side effects. In the logistic regression analyses, the factors associated with poor analgesia (both <50% pain score reduction and postanalgesic pain score of ≥7) were the use of long-acting opioids at home, administration of additional analgesics, provider concern for drug-seeking behavior, and older age. An initial pain score of 10 was also strongly associated with a postanalgesic pain score of ≥7. African American patients who were not taking opioids at home were less likely to achieve a 50% pain score reduction than other patients, despite receiving similar initial and total equianalgesic dosages. None of the variables we assessed were significantly associated with the development of opioid-related side effects. Conclusions: Poor analgesic outcomes were common in this cohort of ED patients prescribed IV opioids. Patients taking long-acting opioids, those thought to be drug-seeking, older patients, those with an initial pain score of 10, and possibly African American patients are at especially high risk of poor analgesia following IV opioid administration.     

A Prospective Study of Hepatic Tuberculosis in 41 Black Patients

Forty-one black patients aged 21 to 75 years with hepatic tuberculosisdiagnosed at liver biopsy were studied prospectively. The livervaried in size and consistency and was tender in 44 per centof patients. Abdominal symploms, weight loss, pyrexia, hepatomegaly,splenomegaly and anaemia were absent in 54, 39, 37, 5, 68 and27 per cent of patients respectively. Twenty-two per cent ofchest radiographs were normal. Liver function tests were oflittle diagnostic value and hepatic imaging techniques oftengave normal results. Acid-fast bacilli, caseation and coexistentliver disease were detected in 59, 51 and 37 per cent of patientsrespectively. Since there was no consistent clinical pattern a high indexof suspicion is necessary if this disease is to be detectedin communities in which tuberculosis is endemic. In patientswith unexplained hepatomegaly or hepatosplenomegaly or pyrexiaof unknown origin liver biopsy provides the only means of makingthis diagnosis.