临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (6): 426-.doi: 10.3969/j.issn.1000-3606.2020.06.007

• 综合报道 • 上一篇    下一篇

儿童幽门螺杆菌根除治疗过程中肠道菌群的变化

于佳鹭,李在玲   

  1. 北京大学第三医院儿科(北京 100191)
  • 出版日期:2020-06-15 发布日期:2020-06-12
  • 通讯作者: 李在玲 电子信箱:topbj163@sina.com

Changes of intestinal flora during Helicobacter pylori eradication therapy in children

YU Jialu, LI Zailing   

  1. Department of Pediatrics, Pecking University Third Hospital, Beijing 100191, China
  • Online:2020-06-15 Published:2020-06-12

摘要: 目的 探讨儿童幽门螺杆菌根除治疗对肠道菌群的影响,并寻找影响根除治疗效果的差异菌群。方法 确诊 幽门螺杆菌感染儿童进行三联标准化方案治疗14天,留取治疗前、治疗7天及14天时的粪便进行16SrDNA测序。根据取 样时间分为治疗前组、治疗7天组、治疗14天组,根据治疗效果分为治疗成功组、治疗失败组,根据既往根治病史分为复 治成功组、初治成功组,分析不同组别之间的菌群差异。结果 幽门螺杆菌感染儿童肠道菌群优势菌门依次为厚壁菌门 、 拟杆菌门、变形菌门、放线菌门、疣微菌门,主要优势菌属有拟杆菌、栖粪杆菌、大肠杆菌/志贺菌、双歧杆菌、Gemmiger、 克雷伯菌。与治疗成功组相比,普氏菌属在治疗失败组相对丰度升高,差异有统计学意义(P<0.001)。 幽门螺杆菌根除治 疗前、治疗7天和14天比较,各肠道菌群相对丰度均发生改变,差异有统计学意义(P<0.05)。LEfSe分析及组间秩和检验 发现,治疗失败组弓形杆菌属、肠道巴恩斯菌属、Coprobacter、粪球菌属、霍尔德曼菌属、假单胞菌属高于治疗成功组,差 异有统计学意义(LDA>2)。 与初治成功组相比,复治成功组不动杆菌属、魏斯菌属、萨特菌属、普罗维登斯菌属显著升高 (LDA>2),另枝菌属、丹毒丝菌属、梭状芽胞杆菌属、粪杆菌属、Gemmiger显著降低(LDA>2)。 结论 幽门螺杆菌根除治 疗影响肠道菌群结构,表现为菌群多样性下降及优势菌群改变。肠道致病性细菌的生长可能影响幽门螺杆菌根除效果,导 致根除治疗失败。

关键词: 幽门螺杆菌; 抗生素; 质子泵抑制剂; 16SrDNA测序; 肠道菌群

Abstract: Objective To investigate the effect of Helicobacter pylori eradication treatment on intestinal flora in children, and to find out the flora that influence the effect of eradication treatment. Methods Children diagnosed with Helicobacter pylori infection were treated with triple standardized treatment for 14 days, and feces were collected before treatment, 7 days after treatment and 14 days after treatment. The 16S rDNA sequencing was performed. According to the sampling time, the children were divided into pre-treatment group, 7-day treatment group, and 14-day treatment group. According to the treatment effect, the children were divided into treatment success group and treatment failure group. According to the history of the previous radical treatment, the children were divided into retreatment successful group and initial treatment successful group. The differences in flora among different groups were compared. Results The dominant Phylum of Helicobacter pylori infection in children were Firmicutes, Bacteroidetes, Proteobacteria, Actinomycetes and Verrucomicrobia, and the dominant bacteria were Bacteroides, Faecalibacterium, Escherichia/Shigella, Bifidobacterium, Gemmiger and Klebsiella. Compared with the treatment success group, the relative abundance of Prevotella was increased in the treatment failure group, and the difference was statistically significant (P<0.001). The relative abundance of intestinal microflora changed among before treatment group, 7-day after treatment group and 14-day after treatment group, and the difference was statistically significant (P< 0.05). LEfSe analysis and rank-sum test between groups found that Arcobacter, Barnesia, Coprobacter, Coprococcus, Holdemanella, Thiopseudomonas were higher in the treatment failure group than those in the treatment success group, and the difference was statistically significant (LDA> 2). Compared with initial treatment successful group, the Acinetobacter, Weissella, Sutterella and Providencia in the retreatment successful group were significantly higher (LDA>2), while Alistipes, Erysipelothrix, Clostridium, Faecalibacterium, and Gemmiger were significantly reduced (LDA>2). Conclusions Helicobacter pylori eradication treatment affects the structure of intestinal flora, which is manifested by the decrease of bacterial diversity and the changes of dominant flora. The growth of enteropathogenic bacteria may affect the eradication effect of Helicobacter pylori and result in the failure of eradication treatment.

Key words: Helicobacter pylori; antibiotics; proton pump inhibitors; 16S rDNA sequencing; intestinal flora