2019 年第 10 期 第 14 卷

反流性食管炎严重程度与食管黏膜菌群结构变化的关系初探

A preliminary study on the relationship between severity of reflux esophagitis and changes of esophageal mucosal microbiome

作者：余英张杰高峰陈雪孙亚梅

英文作者：

单位：100029首都医科大学附属北京安贞医院消化内科

英文单位：

关键词：反流性食管炎；食管黏膜菌群结构；高通量DNA测序技术

英文关键词：

• 摘要：

• 【摘要】目的    探讨反流性食管炎（RE）的严重程度与食管黏膜菌群结构变化的关系。方法    选取2017年5—10月于首都医科大学附属北京安贞医院首次就诊的RE患者32例，经胃镜检查确诊为RE，根据RE洛杉矶分型分为轻度RE组（A和B级，21例）和重度RE组（C和D级，11例）。招募17名健康志愿者作为健康对照组。提取受试者食管下段黏膜样本细菌基因组DNA，采用16S rDNA基因扩增和Illumina测序技术将细菌归类。结果    轻度RE组、重度RE组与健康对照组之间比较，γ-变形菌纲、普氏菌属、螺杆菌属和莫氏杆菌属丰度差异均有统计学意义［9.0(8.5,9.7)%比9.9(9.0,11.1)%比8.7(8.3,9.2)%、 0.12(0.06,0.16)%比0.13(0.09,0.18)%比0.20(0.14,0.35)%、 0.04(0.02,0.07)%比0.02(0.02,0.04)%比0.10(0.03,0.14)%、 0(0,0)%比0(0,0)%比0.002(0,0.019)%］（P＝0.049、0.001、0.034、0.013）。重度RE组胃食管反流病量表(GERDQ)评分较轻度RE组明显升高［8（8,11）分比4（2,8）分］，差异有统计学意义（Z＝－2.876，P＝0.004）。Spearman相关性分析结果显示，RE患者GERDQ评分与厚壁菌门、放线菌门、拟杆菌门、变形菌门均无明显相关性，相关系数分别为0.213（P＝0.242），－0.082（P＝0.657），0.068（P＝0.712），0.204（P＝0.262）。结论    RE患者食管下段黏膜菌群构成较健康受试者出现明显变化，这可能为RE的防治提供新的方向。

• 【Abstract】Objective    To explore the relationship between severity of reflux esophagitis（RE） and changes of esophageal mucosal microbiome. Methods    From May to October 2017, 32 RE patients diagnosed by gastroscopy in Beijing Anzhen Hospital, Capital Medical University were divided into mild RE group(Los Angeles typing A and B, 21 cases) and severe RE group(Los Angeles typing C and D, 11 cases); 17 healthy volunteers were recruited as control group. Distal esophageal mucosal genome DNA was extracted and categorized using 16S rDNA gene amplification and Illumina sequencing technique. Results    There were significant differences of γ-Proteobacteria, Prevotella, Helicobacter and Moraxella abundances among mild RE group, severe RE group and control group［9.0(8.5,9.7)% vs 9.9(9.0,11.1)% vs 8.7(8.3,9.2)%, 0.12(0.06,0.16)% vs 0.13(0.09,0.18)% vs 0.20(0.14,0.35)%, 0.04(0.02,0.07)% vs 0.02(0.02,0.04)% vs 0.10(0.03,0.14)%, 0(0,0)% vs 0(0,0)% vs 0.002(0,0.019)%］（P＝0.049, 0.001, 0.034, 0.013）. Gastroesophageal Reflux Disease Questionaire(GERDQ) score in severe RE group was significantly higher than that in mild RE group［8（8,11） vs 4（2,8）］（Z＝－2.876，P＝0.004）. Spearman analysis showed no correlation of GERDQ score with Firmicutes, Actinobacteria, Bacteroidetes and Proteobacteria; the correlation coefficients were 0.213（P＝0.242）, －0.082（P＝0.657）, 0.068（P＝0.712） and 0.204（P＝0.262）, respectively. Conclusion    The composition of bacterial flora in distal esophageal mucosa of RE patients show obvious changes compared with healthy people, which may provide a new direction for the prevention and treatment of RE.