背景:尽管有很多假设,克罗恩病(CD)的发病机制至今仍不完全清楚。独家肠内营养(EEN)是治疗活动性CD的常规措施。我们旨在研究EEN对来自微生物代谢组学的活性CD患者的影响。
方法:采用16S-rDNA测序技术和气相色谱-质谱分析研究EEN过程中肠道菌群和粪便短链脂肪酸(SCFA)的变化。
结果:7名CD患者,谁主持了EEN,在本研究中成功随访。为期8周的EEN缓解了患有活动性CD的受试者的病情,如红细胞沉降率(ESR)显着降低(P=0.018)所示,C反应蛋白(CRP)(P=0.028),克罗恩病活动指数(CDAI)(P=0.018)。在EEN治疗8周后,受试者的营养得到改善,这与身体脏乱指数(BMI)(P=0.018)和血清白蛋白(ALB)(P=0.018)水平的增加有关。此外,我们的调查显示,Firmicutes的丰度显着增加,同时变形杆菌的水平降低。关于属,五种细菌包括Ruminococus(P=0.01),落叶松科(P=0.02),anaerotruncus(P=0.04),Flavonifractor(P=0.04),和新鞘氨醇(P=0.05)的丰度显着增加。这伴随着粪便短链脂肪酸水平的相对变化。此外,我们通过结合这5个显著不同的属,成功构建了一个稳定的模型来预测EEN对CD患者的治疗效果(AUC=0.9598).
结论:结果表明,EEN可以通过调节肠道菌群和影响粪便短链脂肪酸的表达水平,减轻活动性CD患者的病情和营养。
BACKGROUND: Although there are many hypotheses, the pathogenesis of Crohn\'s disease (CD) is not completely clear so far. Exclusive enteral nutrition (EEN) is a routine measure in the treatment of active CD. We aimed at investigating the impact of EEN on patients with active CD from microbial metabolomics.
METHODS: 16S-rDNA sequencing technology and gas chromatography-mass spectrometer analysis were employed to investigate the modification of the intestinal flora and fecal short-chain fatty acid (SCFA) during the EEN.
RESULTS: Seven patients with CD, who conducted EEN, were followed up successfully in the present study. The 8-week EEN resulted in a remission of the condition of subjects with active CD, as revealed by a significant decrease in erythrocyte sedimentation rate (ESR) (P = 0.018), C-reactive protein (CRP) (P = 0.028), and Crohn\'s disease activity index (CDAI) (P = 0.018). The nutrition of the subjects was improved after an 8-week treatment course with EEN, which was associated with an increase in body mess index (BMI) (P = 0.018) and serum albumin (ALB) (P = 0.018) levels. Furthermore, our investigations revealed a significantly increased abundance of Firmicutes paralleled by decreased levels of Proteobacteria. With respect to the genus, five species of bacteria including Ruminococcus (P = 0.01), Lachnospiraceae (P = 0.02), Anaerotruncus (P = 0.04), Flavonifractor (P = 0.04), and Novosphingobium (P = 0.05) showed significantly increased abundance. This was accompanied by relative changes in fecal short-chain fatty acids levels. Moreover, we successfully constructed a stable model by combining these five significantly different genera to predict the therapeutic effect of EEN on patients with CD (AUC = 0.9598).
CONCLUSIONS: The findings indicated that EEN can alleviate the condition and the nutrition of patients with active CD by regulating the intestinal flora and influencing the expression level of fecal short-chain fatty acids.