慢性胃炎阴虚证证素分布及肠道菌群差异性研究

目的 探讨慢性胃炎阴虚证患者的证素分布情况及肠道菌群差异性，为慢性胃炎患者临床诊断提供参考依据。方法 共收集慢性胃炎阴虚证患者52例，其中慢性萎缩性胃炎(chronic atrophic gastritis, CAG)阴虚证患者35例，慢性非萎缩性胃炎(chronic non-atrophic gastritis, CNAG)阴虚证患者17例，以及健康人31例。采用证素辨证方法分析慢性萎缩性胃炎与慢性非萎缩性胃炎阴虚证的证素分布差异，并运用16S rRNA高通量测序方法进行肠道微生物检测，寻找差异菌群，分析慢性萎缩性胃炎与慢性非萎缩性胃炎阴虚证的证素分布与肠道菌群差异性的关系。结果 (1)证素分布情况:慢性萎缩性胃炎阴虚证的常见病位证素为胃、肝、脾；常见兼夹病性证素为热、气滞、痰、湿、食积、气虚、阳虚、阳亢。慢性非萎缩性胃炎阴虚证的常见病位证素为胃、肝、脾；常见兼夹病性证素为:热、气滞、痰、湿、食积、气虚、血虚、阳虚。两组间各病位证素分布无明显差异；兼夹病性证素在积分的比较中，痰证素(P＜0.05)具有统计学意义。(2)物种组成情况:属水平上，与健康组相比，CAG阴虚组在卟啉单胞菌属和经黏液真杆菌属上的丰度明显增加(P＜0.01)；在嗜胨菌属和Eubacterium_hallii_group菌属上的丰度增加(P＜0.05)；CNAG阴虚组在卟啉单胞菌属和嗜胨菌属上的丰度明显增加(P＜0.01)，在放线菌属上的丰度增加(P＜0.05)，在Lachnospiraceae_UCG010、UCG003菌属和丁酸球菌属的丰度上减少(P＜0.05)。相比CAG阴虚组，CNAG阴虚组在经黏液真杆菌属的丰度上明显减少(P＜0.01)；而CAG阴虚组在厌氧菌属、粪球菌属和丁酸球菌属的丰度上相较于CNAG阴虚组出现明显富集(P＜0.05)。LEfse分析共获得17个生物标记物，CAG阴虚组4个，CNAG阴虚组11个，健康组2个。结论 CAG与CNAG阴虚组的证素分布存在差异，其肠道菌群的多样性及特定菌群丰度存在差异，肠道菌群失调与慢性胃炎的发展密切相关。

Study on the Distribution of Syndrome Elements and the Difference of Gut Microbiota in Yin Deficiency Syndrome of Chronic Gastritis

Objective To explore the distribution of syndrome elements and differences in gut microbiota in patients with chronic gastritis with yin deficiency syndrome, and provide reference for clinical diagnosis of chronic gastritis patients. Methods A total of 52 patients with chronic gastritis with yin deficiency syndrome were collected, including 35 patients with chronic atrophic gastritis(CAG) with yin deficiency syndrome, 17 patients with chronic non atrophic gastritis (CNAG) with yin deficiency syndrome, and 31 healthy individuals. Using the method of syndrome differentiation to analyze the differences in the distribution of syndrome elements between CAG and CNAG with yin deficiency syndrome, and using the 16S rRNA high-throughput sequencing method to detect gut microbiota, identify differential bacterial communities, and analyze the relationship between the distribution of syndrome elements in CAG and CNAG with yin deficiency syndrome and the differences in gut microbiota. Results(1) Distribution of syndrome elements: The common disease locations and syndrome elements of CAG Yin deficiency syndrome are stomach, liver, and spleen; The common and miscellaneous syndrome elements include heat, qi stagnation, phlegm, dampness, food accumulation, qi deficiency, yang deficiency, and yang hyperactivity. The common locations and elements of CNAG Yin deficiency syndrome are stomach, liver, and spleen; The common and miscellaneous syndrome elements include heat, qi stagnation, phlegm, dampness, food accumulation, qi deficiency, blood deficiency, and yang deficiency. There was no significant difference in the distribution of syndrome elements at different locations between the two groups; In the comparison of points, the phlegm syndrome element(P<0.05) has statistical significance in the analysis of concurrent and miscellaneous disease syndrome elements.(2) Species composition: At the genus level, compared with the healthy group, the abundance of CAG Yin deficiency group in the genera Porphyromonas and Actinobacteria increased significantly(P<0.01); In the genus Peptonophilus and Eubacterium_ Hallii_The abundance of group bacteria increased(P<0.05); The abundance of CNAG Yin deficiency group significantly increased (P<0.01) in Porphyromonas and Peptone loving bacteria, and increased (P<0.05) in Actinobacteria_The abundance of bacterial genera UCG010, UCG003, and butyric acid bacteria decreased (P<0.05). Compared with the CAG Yin Deficiency group, the CNAG Yin Deficiency group showed a significant decrease in the abundance of mucinous true bacteria (P<0.01); The CAG Yin deficiency group showed significant enrichment in the abundance of anaerobic bacteria, fecal bacteria, and butyric acid bacteria compared to the CNAG Yin deficiency group (P<0.05). LEfse analysis obtained a total of 17 biomarkers, including 4 in the CAG yin deficiency group, 11 in the CNAG yin deficiency group, and 2 in the healthy group. Conclusion There are differences in the distribution of syndrome elements between CAG and CNAG yin deficiency groups, as well as differences in the diversity and abundance of specific gut microbiota. The imbalance of gut microbiota is closely related to the development of chronic gastritis.