■近年来,肠道菌群和代谢产物在肾脏疾病中的作用越来越受到关注。已经确定,肠道微生物群是肾脏疾病包括慢性肾脏疾病(CKD)的医学干预的潜在目标。急性肾损伤(AKI)和肾结石。新的证据表明,透析治疗与肠道的微生物组成和功能有关,有很多关于HD的报道,但很少有研究与PD有关。以前的研究发现PD患者有肠道菌群紊乱,因此,我们推测肠道菌群及其代谢产物可能是PD长期治疗的调节因素。据我们所知,没有研究对不同透析年份的PD患者的肠道菌群进行了表征.
■这是一项基于72例CAPD患者的临床数据和生物学样本的横断面研究,13例ESRD患者和13例健康志愿者。结合患者肠道菌群结构,综合评价CAPD患者的肠道微生态特征,肠毒素和受体(血清LPS和LBP),肠屏障功能指数(血清D-乳酸),肠道尿毒症毒素(血清IS,PCS,TMAO),粪便SCFA和其他多维和多组学研究。此外,不同透析年限(≥3个月和<12个月,CAPD患者肠道微生态变化,≥12个月且<24个月,≥24个月且<60个月,≥60个月)进行了进一步探索,并分析肠道微生态指标与部分临床指标的相关性。收集PD患者的粪便和血清样本(PD组,n=72),ESRD患者(ESRD组,n=13)和健康志愿者(正常组,n=13)。对粪便样品进行微生物组(16SrDNA)和SCFA(GC-MS)分析。血清样品接受LPS,LBP,D-乳酸,IS,PCS,和TMAO(ELISA)分析。
■CAPD患者肠道菌群的多样性和丰富度低于健康人和ESRD患者,微生物区系结构不同。布劳特氏菌的厌氧菌和兼性厌氧菌和需氧菌以及Firmicutes中的芽孢杆菌和乳酸杆菌是CAPD患者的主要肠道菌群。丰富的拟杆菌科,拟杆菌,CAPD患者肠道中的粪杆菌和其他优势细菌减少。变形杆菌,肠杆菌科和大肠杆菌志贺氏菌的定植增加(LDA>4)。在不同透析年份的CAPD患者中,微生物多样性和丰富度没有显著变化,PDC组的微生物区系结构与PDD组明显不同,其中PDC中肠杆菌群的异常扩张更为突出,PDD中拟杆菌群的丰度相对较高。肠屏障损伤,在CAPD患者中观察到肠道尿毒症毒素积累和短链脂肪酸减少,如D-乳酸的血清水平,PCs和TMAO显著高于正常组(P<0.05),粪便中BA和CA含量明显降低(P<0.05)。PDC组肠道微生态紊乱,PDD组表现出更好的趋势。如PDC组有显著较高的血清LPS程度,D-乳酸和TMAO(P<0.01),血清LBP水平显著降低(P<0.01),粪便中AA和BA水平低于PDD组(P>0.05)。
■CAPD患者的肠道微生态和代谢系统与健康人和ESRD非透析患者相比发生了变化,不同透析年份的CAPD患者存在差异。透析60个月以上的PD患者的肠道微生态比透析24~36个月的患者表现出更好的趋势,提示在规范化制度管理下,PD患者肠道微生态具有一定的自我调节和重塑能力,应加强对透析24~36个月透析患者肠道状态及相关并发症发生的监测。初步认为肠道微生态机制是CAPD诊断和治疗干预的潜在目标,将肠道微生态监测纳入CAPD患者的长期管理是一种新策略。
UNASSIGNED: In recent years, the role of gut microbiota and derived metabolites in renal disease has attracted more attention. It has been established that the gut microbiota is a potential target for medical interventions in renal disease including chronic kidney disease (CKD), acute kidney injury (AKI) and renal calculus. Emerging evidence has related dialysis treatment to the microbial composition and function of the intestines, and there are many reports related to HD, but few studies have been related to PD. Previous studies have found that PD patients have intestinal flora disturbances, so we speculate that intestinal flora and its metabolites may be the regulatory factors in long-term therapy of PD. And as far as we know, there have been no studies characterized the gut microbiota in PD patients of different dialysis vintages.
UNASSIGNED: It is a cross-sectional study based on clinical data and biological samples of 72 patients with CAPD, 13 patients with ESRD and 13 healthy volunteers. The intestinal microecological characteristics of CAPD patients were comprehensively evaluated by combining the intestinal microflora structure, enterotoxin and receptor (serum LPS and LBP), intestinal barrier function index (serum D-Lactate), intestinal uremic toxin (serum IS, PCS, TMAO), fecal SCFAs and other multi-dimensional and multi-omics studies. Furthermore, the changes of intestinal microecology in CAPD patients of different dialysis vintages (≥ 3 and < 12 months, ≥ 12 and < 24 months, ≥ 24 and < 60 months, ≥ 60 months) were further explored, and the correlations between intestinal microecology indicators and some clinical indicators were analyzed. Fecal and serum samples were collected from PD patients (PD group, n = 72), ESRD patients (ESRD group, n = 13) and healthy volunteers (Normal group, n = 13). Fecal samples were subjected to microbiome (16S rDNA) and SCFA (GC-MS) analyses. Serum samples were subjected to LPS, LBP, D-lactate, IS, PCS, and TMAO (ELISA) analyses.
UNASSIGNED: The diversity and richness of intestinal flora in CAPD patients were lower than those in healthy people and ESRD patients, and the microflora structure was different. Anaerobes of Blautia and facultative anaerobes and aerobic bacteria with Bacilli and Lactobacillales those in Firmicutes are the main intestinal flora in CAPD patients. The abundance of Bacteroidaceae, Bacteroides, Faecalibacterium and other dominant bacteria in the intestinal tract of CAPD patients decreased. Proteobacteria, Enterobacteriaceae and Escherichia-Shigella increased their colonization (LDA > 4). In CAPD patients of different dialysis vintages, there was no significant change in the diversity and richness of microflora, and the microflora structure of PDC group was significantly different from that of PDD, which the abnormal expansion of enterobacter group was more prominent in PDC and the abundance of Bacteroides group was relatively higher in PDD. Intestinal barrier damage, intestinal uremic toxin accumulation and short-chain fatty acid reduction were observed in CAPD patients, such as the serum level of D-Lactate, PCS and TMAO were significantly higher than that in the Normal group (P < 0.05),and the fecal levels of BA and CA were significantly lower (P < 0.05). The intestinal microecological disorder of PDC group, while that of PDD group showed a better trend. Such as the PDC group had a significantly higher serum level of LPS, D-Lactate and TMAO (P < 0.01), and significantly lower serum level of LBP (P < 0.01), and lower fecal levels of AA and BA (P > 0.05) than the PDD group.
UNASSIGNED: The intestinal microecology and metabolic system of CAPD patients had changes compared with healthy people and ESRD non-dialysis patients, and there were differences in CAPD patients with different dialysis vintages. PD patients on dialysis for more than 60 months showed a better trend in the intestinal microecology than patients with 24∼36 months, which suggested that the intestinal microecology of PD patients had a certain ability of self-regulation and remodeling under the management of standardized system and it is necessary to strengthen the monitoring of the intestinal status and the occurrence of related complications in PD patients on dialysis of 24∼36 months of dialysis vintage. It is initially considered that the mechanism of intestinal microecology is a potential target for intervention in the diagnosis and treatment of CAPD and incorporating intestinal microecosystem monitoring into the long-term management of CAPD patients is a new strategy.