摘要
目的观察儿童重症监护室(PICU)脓毒症患儿肠道菌群结构变化,并分析其与患儿营养指标的关联性,以期为临床决策的制定提供参考。方法选取2022年1月—2024年6月本院收治的104例脓毒症患儿作为研究对象。所有患儿接受肠道菌群结构和营养指标[白蛋白(ALB)、皮下脂肪厚度]检测,并分析肠道菌群结构变化与营养指标的关系。结果营养缺乏患儿体质量低于营养正常患儿,PICU住院时间长于营养正常患儿,差异均有统计学意义(P<0.05);2组患儿性别分布、年龄、身高等比较,差异均无统计学意义(P>0.05)。在门水平上,营养缺乏患儿厚壁菌门、拟杆菌门相对丰度低于营养正常患儿,差异有统计学意义(P<0.05);变形菌门相对丰度高于营养正常患儿,差异有统计学意义(P<0.05)。在属水平上,营养缺乏患儿乳酸菌属、另枝菌属、粪球菌属相对丰度低于营养正常患儿,差异有统计学意义(P<0.05);克雷伯菌属、埃希氏-志贺菌属、链球菌属相对丰度高于营养正常患儿,差异有统计学意义(P<0.05)。Pearson相关分析显示:在门水平上的厚壁菌门、拟杆菌门及在属水平上的乳酸菌属、另枝菌属、粪球菌属相对丰度与患儿ALB、皮下脂肪厚度呈正相关(P<0.05),在门水平上的变形菌门及在属水平上的克雷伯菌属、埃希氏-志贺菌属、链球菌属相对丰度与患儿ALB、皮下脂肪厚度呈负相关(P<0.05)。多重线性回归分析结果显示:变形菌门、克雷伯菌属、埃希氏-志贺菌属相对丰度是患儿ALB水平的影响因素(P<0.05);另枝菌属、埃希氏-志贺菌属相对丰度是患儿皮下脂肪厚度的影响因素(P<0.05)。结论PICU脓毒症患儿肠道菌群结构紊乱,且其与营养指标ALB水平、皮下脂肪厚度降低有关。临床应关注患儿肠道菌群结构的变化,以防范患儿营养不良风险并早期给予干预。
Objective To observe changes in gut microbiota structure in pediatric sepsis patients in the pediatric intensive care unit(PICU)and analyze its association with patients'nutritional indicators,so as to provide a reference for clinical decision-making.Methods A total of 104 pediatric sepsis patients admitted to our hospital from January 2022 to June 2024 were enrolled.All patients underwent gut microbiota profiling and nutritional indicator testing(albumin[ALB]and subcutaneous fat thickness),and the relationships between gut microbiota alterations and nutritional indicators were analyzed.Results Children with malnutrition had lower body mass and longer PICU length of stay than children with normal nutrition,and the differences were statistically significant(P<0.05);no significant differences were noted in sex distribution,age,height,and other baseline characteristics between the two groups(P>0.05).At the phylum level,the relative abundances of Firmicutes and Bacteroidetes were significantly lower in malnourished children than in well-nourished children(P<0.05),while Proteobacteria relative abundance was significantly higher in malnourished children(P<0.05).At the genus level,the relative abundances of Lactobacillus,Alistipes,and Coprococcus were significantly lower in malnourished children than in well-nourished children(P<0.05),whereas Klebsiella,Esche-richia-Shigella,and Streptococcus were significantly more abundant in malnourished children(P<0.05).Pearson correlation analysis showed that,at the phylum level,the relative abundances of Firmicutes and Bacteroidetes,and at the genus level,the relative abundances of Lactobacillus,Alistipes and Coprococcus were positively correlated with patients'ALB and subcutaneous fat thickness(P<0.05);conversely,the relative abundance of Proteobacteria at the phylum level and Klebsiella,Escherichia-Shigella,and Streptococcus at the genus level were negatively correlated with ALB and subcutaneous fat thickness(P<0.05).Multiple linear regression analysis indicated that the relative abundances of Proteobacteria,Klebsiella,and Escherichia-Shigella were factors influencing patients'ALB levels(P<0.05),and the relative abundances of Alistipes and Escherichia-Shigella were factors influencing patients'subcutaneous fat thickness(P<0.05).Conclusion Gut microbiota structure is disrupted among pediatric patients with sepsis in the PICU,and this disorder is associated with decreased nutritional indicators(ALB levels)and subcutaneous fat thickness.Clinicians should monitor changes in gut microbiota structure to prevent malnutrition risk and provide early interventions.
作者
杨可可
刘祥蕾
杨林风
周碧
朱峰
阚月月
黄水英
Yang Keke;Liu Xianglei;Yang Linfeng;Zhou Bi;Zhu Feng;Kan Yueyue;Huang Shuiying(Department of Pediatric Critical Care Medicine,The Affiliated Suzhou Hospital of Anhui Medical University,Suzhou Anhui 234000,China;Department of Pediatrics,The Affiliated Suzhou Hospital of Anhui Medical University,Suzhou Anhui 234000,China)
出处
《保健医学研究与实践》
2025年第9期96-101,共6页
Health Medicine Research and Practice
基金
2024年度安徽省卫生健康科研项目(AHWJ2024Aa30139)。
