新生儿胆汁淤积性黄疸血清胆红素水平与肠道菌群失调的相关性

目的 探讨新生儿胆汁淤积性黄疸血清胆红素水平与肠道菌群失调的相关性。方法 选取2019年8月至2021年8月南阳市中心医院的新生儿胆汁淤积性黄疸患儿109例,同时选取母乳性黄疸患儿68例,健康新生儿80例。检测3组血清中胆红素水平和粪便标准肠道菌群,对比3组门水平优势菌群和属水平优势菌群的差异,采用Pearson相关系数分析血清胆红素水平与肠道菌群及肠道菌群失调的相关性。结果 胆汁淤积症组丙氨酸氨基转移酶(ALT)、直接胆红素水平和总胆红素比值(DBIL/TBIL)明显高于健康组和母乳性黄疸组(P均<0.05),胆汁淤积症组Ⅱ度菌群失调和Ⅲ度菌群失调占比明显高于健康组和母乳性黄疸组(P<0.05);胆汁淤积症组拟杆菌门和厚壁菌门水平显著高于母乳性黄疸组和健康组(P<0.05),胆汁淤积症组变形菌门水平显著低于母乳性黄疸组(P<0.05),胆汁淤积症组中放线菌门水平明显低于健康组和母乳性黄疸组(P均<0.05);胆汁淤积症组双歧杆菌和乳酸杆菌丰度显著低于健康组和母乳性黄疸组(P<0.05),胆汁淤积症组大肠杆菌和肠球菌丰度明显高于健康组和母乳性黄疸组(P<0.05),胆汁淤积症组双歧杆菌/大肠杆菌(B/E)值低于健康组和母乳性黄疸组(P<0.05);Pearson相关分析发现,ALT、TBIL、DBIL、DBIL/TBIL与拟杆菌门、厚壁菌门呈正相关(均P<0.05),与放线菌门呈负相关(均P<0.05);TBIL与双歧杆菌、B/E值呈负相关(均P<0.05),与大肠杆菌、肠球菌呈正相关(均P<0.05);DBIL与双歧杆菌、B/E值呈负相关(均P<0.05);DBIL/TBIL与双歧杆菌、大肠杆菌、肠球菌、B/E值呈负相关(均P<0.05)。结论 胆汁淤积性黄疸患儿菌群失调,双歧杆菌明显减少,且血清胆红素水平与菌群具有一定的相关性,积极补充益生菌可能成为治疗胆汁淤积性黄疸一种有效方式。

Correlation between serum bilirubin level and the imbalance of the normal gut microbiota in neonates with cholestatic jaundice

Objective To investigate the correlation between serum bilirubin level and the imbalance of normal gut microbiota in neonates with cholestatic jaundice. Methods A total of 109 neonates with cholestatic jaundice treated in Nanyang Central Hospital from August 2019 to August 2021were selected as the cholestatic jaundice group, 68 neonates with breast milk jaundice were selected as the breast milk jaundice group, and 80 healthy neonates during the same period were selected as the healthy group. Serum bilirubin level andgut microbiotain stools were detected. Differences in the dominant flora at the level of phylum and genus in three groups were compared. The correlation between serum bilirubin level and the imbalance of normal gut microbiota was analyzed by Pearson’s correlation coefficient. Results Serum level of alanine aminotransferase (ALT) and direct bilirubin and total bilirubin ratio (DBIL/TBIL) in cholestatic jaundice group were significantly higher than those in healthy group and breast milk jaundice group (all P<0.05). The proportion of grade Ⅱ and Ⅲ imbalance of gut microbiota was significantly higher in cholestatic jaundice group than that in the healthy group and breast milk jaundice group (P<0.05).The abundances of Bacteroides and Firmicutes in cholestatic jaundice group were significantly higher than those in breast milk jaundice group and healthy group (P<0.05).The abundances of Bifidobacteria and Lactobacillus in cholestatic jaundice group were significantly lower than that in healthy group and breast milk jaundice group (P<0.05), and the abundances of Escherichia coli and Enterococcus in cholestatic jaundice group weresignificantly higher than that in healthy group and breast milk jaundice group (P<0.05). The ratio of Bifidobacteria/Escherichia coli (B/E) in cholestatic jaundice group was significantly lower than that in healthy group and breast milk jaundice group (P<0.05).ALT, TBIL, DBIL, DBIL/TBIL were positively correlated with the abundances of Bacteroides and Firmicutes (all P<0.05), and negatively correlated with that of Actinomyces (all P<0.05).TBIL was negatively correlated with the abundance of Bifidobacterium and B/E (P<0.05), and positively correlated with abundances of Escherichia coli and Enterococcus (P<0.05).DBIL was negatively correlated with the abundance of Bifidobacterium and B/E (P<0.05) DBIL/TBIL were negatively correlated with the abundances of Bifidobacterium, Escherichia coli, and Enterococcus, and B/E (all P<0.05). Conclusion The gut microbiota of neonates with cholestatic jaundice is imbalance, with significantly reduced abundance of Bifidobacteria, and the serum bilirubin level has a certain correlation with the gut microbiota. An active supplement of probiotics may be an effective way to treat cholestatic jaundice.