脓毒症相关急性肾损伤肠道菌群特点及相关性分析

Characteristics and Correlation Analysis of Intestinal Microbiota in Sepsis-Associated Acute Kidney Injury

摘要

目的：探讨脓毒症相关急性肾损伤（sepsis-associated acute kidney injury，SA-AKI）患者肠道菌群的结构特征，分析其与临床严重程度及炎症反应指标的相关性，为揭示SA-AKI的发病机制和寻找新的治疗靶点提供依据。方法：选取45例SA-AKI患者作为病例组，30例健康者作为对照组。收集粪便样本，分析肠道菌群的α多样性和β多样性以及微生物组成，评估菌群与临床指标之间的相关性。结果：与对照组相比，病例组患者肠道菌群α多样性（Shannon指数和Chao指数）显著降低（P<0.05）。病例组患者的变形菌门（Proteobacteria）丰度显著升高，而厚壁菌门（Firmicutes）和拟杆菌门（Bacteroidetes）的比例则显著下降。相关性分析表明，肠球菌属的丰度与SOFA评分、血清肌酐水平均呈显著正相关，而普拉梭菌属的丰度与白细胞介素-6（interleukin-6，IL-6）水平呈显著负相关。结论：SA-AKI患者存在显著的肠道菌群失调，表现为菌群多样性降低、结构改变、机会性致病菌过度生长，且与疾病的严重程度和全身炎症反应密切相关，这些菌群有望成为潜在生物标记物和治疗靶点。

Abstract

Objective: To explore the structural characteristics of intestinal microbiota in patients with sepsis-associated acute kidney injury (SA-AKI) and analyze its correlation with clinical severity and inflammatory response indicators, so as to provide evidence for elucidating the pathogenesis of SA-AKI and identifying novel therapeutic targets. Methods: A total of 45 patients with SA-AKI were selected as the case group, and 30 healthy individuals were included as the control group. Fecal samples were collected to analyze the α-diversity and β-diversity of the intestinal microbiota as well as the microbial composition. The correlation between the microbiota and clinical indicators was also evaluated. Results: Compared with the control group, the α-diversity (Shannon index and Chao index) of the intestinal microbiota in the case group was significantly reduced (P<0.05). The abundance of Proteobacteria was significantly increased in patients of the case group, while the proportions of Firmicutes and Bacteroidetes were markedly decreased. Correlation analysis revealed that the abundance of Enterococcus was significantly positively correlated with both the Sequential Organ Failure Assessment (SOFA) score and serum creatinine levels, whereas the abundance of Faecalibacterium was significantly negatively correlated with interleukin-6 levels. Conclusion: Significant intestinal dysbiosis is present in patients with SA-AKI, characterized by reduced microbial diversity, altered microbial structure, and overgrowth of opportunistic pathogens. This dysbiosis is closely associated with the severity of the disease and systemic inflammatory response. These microbial taxa hold promise as potential biomarkers and therapeutic targets.

关键词

脓毒症 / 急性肾损伤 / 肠道菌群 / 16S rRNA测序 / 生物标记物

Key words

sepsis / acute kidney injury / intestinal microbiota / 16S rRNA sequencing / biomarkers

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基金资助

2025年张家口市科技计划财政资助项目(No.2511033A)