老年维持性血液透析患者营养状况与肠道菌群分布的关系研究

Relationship between nutritional status and intestinal flora distribution in elderly patients undergoing maintenance hemodialysis

摘要:

目的 探讨老年维持性血液透析（MHD）患者营养状况与肠道菌群分布的关系。方法 选取2022年1月—2025年1月在北大荒集团建三江医院进行MHD的121例老年患者作为研究对象，通过改良定量主观整体评估表（MQSGA）评价患者营养状况，根据结果将患者分为营养正常组（70例）和营养不良组（51例）。收集所有患者的粪便样本，利用16S rRNA测序技术和Qiime软件进行肠道菌群α多样性分析［Chao1指数、observed species（Sobs）指数、Shannon指数、Simpson指数］，并检测两组营养相关生化指标［白蛋白（Alb）、前白蛋白（PA）、转铁蛋白（TRF）、血红蛋白（Hb）］。通过多因素一般Logistic回归模型分析肠道菌群α多样性对老年MHD患者营养不良的影响。采用Pearson相关性分析探讨肠道菌群与营养指标的关系。结果 营养正常组Chao1指数、Sobs指数、Shannon指数和Simpson指数均高于营养不良组（P <0.05）。营养正常组Alb、PA、TRF、Hb均高于营养不良组（P <0.05）。多因素一般Logistic回归分析结果显示，Chao1指数小［O^R=0.098（95% CI：0.029，0.331）］、Sobs指数小［O^R=0.118（95% CI：0.033，0.430）］、Shannon指数小［O^R=0.330（95% CI：0.146，0.747）］和Simpson指数小［O^R=0.135（95% CI：0.040，0.463）］均为患者发生营养不良的危险因素（P <0.05）。Chao1指数与Alb、PA、TRF和Hb水平均呈正相关（r =0.405、0.461、0.230、0.262，均P <0.05）；Sobs指数与Alb水平、PA水平、TRF水平和Hb水平均呈正相关（r =0.393、0.602、0.394、0.244，均P <0.05）；Shannon指数与Alb水平、PA水平、TRF水平和Hb水平均呈正相关（r =0.181、0.253、0.280、0.193，均P <0.05）；Simpson指数与Alb水平、PA水平、TRF水平和Hb水平均呈正相关（r =0.364、0.403、0.373、0.195，均P <0.05）。结论 肠道菌群多样性与营养状况密切相关，且肠道菌群α多样性降低是老年MHD患者发生营养不良的风险因素。

Abstract:

Objective To analyze the relationship between nutritional status and intestinal flora distribution in elderly patients undergoing maintenance hemodialysis (MHD).Methods A total of 121 elderly patients who received MHD in our hospital from January 2022 to January 2025 were selected as the research subjects. The Modified Quantitative Subjective Global Assessment (MQSGA) was used to evaluate the patients' nutritional status, and the patients were divided into the normal nutrition group (n = 70) and the malnutrition group (n = 51) according to the evaluation results. Fecal samples of all patients were collected, and 16S rRNA sequencing technology and the Qiime software were used to analyze the α-diversity of intestinal flora [including Chao1 index, observed species (Sobs)index, Shannon index, and Simpson index]. Meanwhile, nutrition-related biochemical indicators [albumin (ALB), prealbumin (PA), transferrin (TRF), and hemoglobin (Hb) ] were detected in both groups. Logistic regression analysis was used to explore the effect of intestinal flora α-diversity on malnutrition in elderly MHD patients, and Pearson correlation analysis was performed to investigate the relationship between intestinal flora and nutritional indicators.Results The normal nutrition group had higher Chao1 index, Sobs index, Shannon index, and Simpson index than the malnutrition group (P < 0.05). The levels of ALB, PA, TRF, and Hb in the normal nutrition group were higher than those in the malnutrition group, with statistically significant differences (all P < 0.05). Multivariable general logistic regression analysis showed that lower Chao1 index [O^R = 0.098 (95% CI: 0.029, 0.331) ], lower Sobs index [O^R = 0.118 (95% CI: 0.033, 0.430) ], lower Shannon index [O^R = 0.330 (95% CI: 0.146, 0.747) ] and lower Simpson index [O^R = 0.135 (95% CI: 0.040, 0.463) ] were all risk factors for malnutrition in patients (all P < 0.05). The Chao1 index was positively correlated with ALB, PA, TRF, and Hb levels (r = 0.405, 0.461, 0.230, and 0.262, respectively; all P < 0.05). The Sobs index was also positively correlated with ALB, PA, TRF, and Hb levels (r = 0.393, 0.602, 0.394, and 0.244, respectively; all P < 0.05). Similarly, the Shannon index showed positive correlations with ALB, PA, TRF, and Hb levels (r = 0.181, 0.253, 0.280, and 0.193, respectively; all P < 0.05), and the Simpson index was positively correlated with ALB, PA, TRF, and Hb levels (r = 0.364, 0.403, 0.373, and 0.195, respectively; all P < 0.05).Conclusion Intestinal flora diversity is closely related to nutritional status, and the decrease in the α-diversity of intestinal flora is a risk factor for malnutrition in elderly patients undergoing MHD.