陈茜茜 朱海勇

[摘要] 目的 观察溃疡性结肠炎患者活动期肠道菌群及粪便炎症标志物含量及其临床意义。 方法 回顾性分析2018年3月至2021年1月在我院治疗的60例溃疡性结肠炎患者的临床资料，按照病情状况分为活动期组（n=39）与缓解期组（n=21），同时选择在我院体检的50名健康者为对照组。比较三组研究对象的肠道需氧菌群（包括酵母菌、肠球菌、葡萄球菌、肠杆菌）、厌氧菌群（包括双歧杆菌、拟杆菌、乳杆菌、真杆菌、消化球菌）以及粪便炎症标志物乳铁蛋白（LF）、钙卫蛋白（FC）、髓过氧化酶（MPO）、基质金属蛋白酶-9（MMP-9）的水平。 结果 活动期组酵母菌、肠球菌、葡萄球菌、肠杆菌数量明显高于缓解期组与对照组，缓解期组酵母菌、肠球菌、肠杆菌数量明显高于对照组（P<0.05）;活動期组双歧杆菌、乳杆菌、真杆菌明显低于缓解期组与对照组，拟杆菌、消化球菌明显高于缓解期组与对照组，缓解期组双歧杆菌、乳杆菌、真杆菌明显低于对照组，拟杆菌、消化球菌明显高于对照组（P<0.05）;活动期组LF、FC、MPO、MMP-9水平明显高于缓解期组与对照组，缓解期组LF、FC、MPO、MMP-9水平明显高于对照组（P<0.05）。 结论 溃疡性结肠炎患者肠道菌群失调，粪便中炎症标志物水平明显较高，能够通过肠道菌群变化及粪便内LF、FC、MPO、MMP-9水平评估疾病的活动性。

[关键词] 溃疡性结肠炎;活动期;需氧菌群;厌氧菌群;乳铁蛋白;钙卫蛋白;髓过氧化酶;基质金属蛋白酶-9

[中图分类号] R574.62          [文献标识码] A          [文章编号] 1673-9701（2021）34-0016-04

[Abstract] Objective To observe the levels of intestinal flora and fecal inflammation markers in patients with ulcerative colitis and its clinical significance. Methods The clinical data of 60 patients with ulcerative colitis admitted to our hospital from March 2018 to January 2021 were retrospectively analyzed. According to their condition， the patients were divided into the active period group（n=39） and the remission period group（n=21）. At the same time， 50 healthy people who had a physical examination in our hospital were selected as the control group. The intestinal aerobic flora （including yeast， enterococcus， staphylococcus， and enterobacteriaceae）， the anaerobic flora（including bifidobacterium， bacteroides， lactobacillus， eubacterium， peptococcus）， and the fecal inflammation markers lactoferrin（LF）， calprotectin （FC）， myeloperoxidase （MPO）， matrix metalloproteinase-9 （MMP-9） between the three groups were compared and analyzed. Results The numbers of enterococcus， staphylococci， and enterobacteriaceae in the active stage group were significantly higher than those in the remission stage group and the control group. The numbers of yeast， enterococcus， and enterobacteriaceae in the remission stage group were significantly higher than those in the control group. The differences were statistically significant（P<0.05）. The bifidobacterium， lactobacillus， eubacteria in the active period group were significantly lower than those in the remission stage group and the control group. The bacteroides and peptococcus in the active period group were significantly higher than those in the remission stage group and the control group. The bifidobacterium， lactobacillus， and eubacteria in the remission stage group were significantly lower than those in the control group. The bacteroides and peptococcus in the remission stage group were significantly higher than those in the control group. The differences were statistically significant （P<0.05）. The levels of LF， FC， MPO， and MMP-9 in the active stage group were significantly higher than those in the remission group and the control group. The levels of LF， FC， MPO， and MMP-9 in the remission stage group were significantly higher than those in the control group， and the differences were statistically significant（P<0.05）. Conclusion In patients with ulcerative colitis， the intestinal flora is imbalanced， and the level of fecal inflammatory markers is significantly higher. The activity of the disease can be assessed by the changes in the intestinal flora and the levels of LF， FC， MPO， and MMP-9 in feces.

[Key words] Ulcerative colitis; Active stage; Aerobic flora; Anaerobic flora; Lactoferrin; Calprotectin; Myeloperoxidase; Matrix metalloproteinase-9

溃疡性结肠炎的发病原因还没有完全明确，现在大多数学者认为是由遗传易感、环境、免疫功能不正常、肠道屏障功能出现障碍等诸多原因引发，其中，免疫应答紊乱与慢性炎症反应为引发溃疡性结肠炎的重要环节，肠道中的菌群紊亂是导致免疫应答变化、炎症反应的一个关键因素，是发生溃疡性结肠炎的关键因素[1-3]。近几年，多项文献[4-5]，肠道内菌群的不协调与溃疡性结肠炎息息相关。通常来说炎症性肠病肠道内的菌群组成变化主要有多样性减少、黏膜总菌改变、于疾病进展期菌群组成变化，像增加侵袭性细菌的类型、减少保护性菌的数量[6]。……