摘要
目的探讨头孢噻肟联合左氧氟沙星治疗社区获得性肺炎(CAP)对患者肠道菌群结构和多样性的影响。方法选择2018年10月至12月浙江省立同德医院感染科收治的CAP住院患者6例,予头孢噻肟注射液2.0 g(1次/8 h)联合左氧氟沙星注射液0.5 g(1次/d)静脉给药治疗,留取患者抗菌药物治疗前和经7 d治疗后粪便样本共12份,采用自身配对设计研究,对治疗前后的粪便样本进行16S核糖体RNA(16S rRNA)测序分析。结果⑴治疗前和治疗后患者肠道菌群的组成结构:在门水平:厚壁菌门59.2%vs 40.8%,变形菌门18.6%vs 35.5%,拟杆菌门14.8%vs 20.8%,放线菌门5.6%vs 1.2%;在科水平:瘤胃菌科34.5%vs 13.0%、毛螺菌科15.9%vs 9.7%、韦荣球菌科1.8%vs 3.3%、乳杆菌科0.3%vs 8.0%、肠球菌科0.02%vs 5.2%、链球菌科2.9%vs 1.1%、肠杆菌科16.4%vs 34.6%、拟杆菌科13.3%vs 16.8%、紫单胞菌科0.3%vs 3.4%、红蝽杆菌科4.4%vs 0.5%。治疗前后患者肠道菌群的组成结构比较差异无统计学意义(P>0.05)。⑵治疗前和治疗后患者肠道菌群的多样性:OTU值(150.5±59.0)vs(93.2±34.1),t=2.72,P=0.04;Chao1指数(169.25±49.61)vs(117.92±35.06),t=3.22,P=0.02;shannon指数(3.61±0.83)vs(2.31±0.73),t=4.54,P=0.01;simpson指数(0.80±0.10)vs(0.61±0.20),t=2.76,P=0.04。治疗前后患者肠道菌群的多样性比较差异均有统计学意义(P<0.05)。⑶脱硫弧菌为治疗前和治疗后组间差异有统计学意义的菌群,LDA值=2.03,P=0.02。结论头孢噻肟联合左氧氟沙星治疗一周对CAP患者肠道菌群的多样性有显著影响,治疗后肠道菌群的多样性明显减少,脱硫弧菌是治疗前和治疗后差异有统计学意义的菌种。
Objective To explore the structure and diversity of intestinal flora in patients with community acquired pneumonia(CAP)before and after treatment with cefotaxime combined with levofloxacin.Methods From October to December 2018,6 patients with CAP in the Department of Infection,Zhejiang Provincial Hospital of Tongde,were treated with cefotaxime injection 2.0 g(once/8 h)combined with 0.5 g levofloxacin injection(once a day).A total of 12 fecal samples were collected before and after 7 days of treatment.The stool samples before and after treatment were analyzed by 16S rRNA sequencing.Results⑴The structure of intestinal flora before and after treatment:at the phylum level:Firmicutes 59.2%vs 40.8%,Proteobacteria 18.6%vs 35.5%,Bacteroidetes 14.8%vs 20.8%,Actinobacteria 5.6%vs 1.2%;At the family level:Ruminococcaceae 34.5%vs 13.0%,Lachnospiraceae 15.9%vs 9.7%,Veillonellaceae 1.8%vs 3.3%,Lactobacillaceae 0.3%vs 8.0%,Streptococcaceae 2.9%vs 1.1%,Enterococcaceae 0.02%vs 5.2%,Enterobacteriaceae 16.4%vs 34.6%,Bacteroidaceae 13.3%vs 16.8%,Porphyromonadaceae 0.3%vs 3.4%,Adlercreutzia 4.4%vs 0.5%.There was no significant difference in the composition and structure of intestinal flora before and after treatment(P>0.05).⑵The diversity of intestinal flora before and after treatment:operational taxonomic units(OTU)mean(150.5±59.0)vs(93.2±34.1),t=2.72,P=0.04;Chao1 index(169.25±49.61)vs(117.92±35.06),t=3.22,P=0.02;shannon index(3.61±0.83)vs(2.31±0.73),t=4.54,P=0.01;simpson index(0.80±0.10)vs(0.61±0.20),t=2.76,P=0.04.There were significant differences in the diversity of intestinal flora before and after treatment(P<0.05).⑶There was significant difference in desulfovibrio between the two groups before and after treatment(LDA=2.03,P=0.02).Conclusions After intravenous infusion of cefotaxime combined with levofloxacin for one week,the diversity of intestinal flora was significantly reduced after treatment.Desulfovibrio was the flora with statistical differences between before and after treatment.
作者
翁卫东
饶先林
陆峰彬
张永乐
邓通洋
Weng Weidong;Rao Xianlin;Lu Fengbin;Zhang Yongle;Deng Tongyang(Department of Infection,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China;Department of Clinical laboratory,Tongde Hospital of Zhejiang Province,Hangzhou 310012,China)
出处
《中国医师杂志》
CAS
2020年第11期1690-1694,共5页
Journal of Chinese Physician
