高血压脑出血患者肠道菌群改变及其与术后神经认知障碍的关系探讨-东南大学学报医学版

高血压脑出血患者肠道菌群改变及其与术后神经认知障碍的关系探讨

单位：1. 广西中医药大学, 广西南宁 530200;
2. 广西中医药大学附属瑞康医院麻醉科, 广西南宁 530011;
3. 广西医科大学第一附属医院消化内科, 广西南宁 530011

分类号：R743.2;R749.1;R378.2

出版年·卷·期（页码）：2025·44·第三期（447-452）

摘要：

目的: 观察高血压脑出血(HICH)患者肠道菌群改变,并分析其与术后神经认知障碍(PND)的关系。方法: 选取2020年10月至2023年7月收治的HICH患者237例,检测其肠道菌群。根据HICH患者是否发生PND将其分为发生组和未发生组,比较两组肠道菌群变化和一般资料,并探讨HICH患者肠道菌群改变与PND的关系。结果: 发生组脑出血量、入院时美国国立卫生研究院卒中量表(NIHSS)评分以及梭菌属、埃希菌属、布劳特菌属、颤杆菌克属、拟杆菌属水平相对丰度高于未发生组(P＜0.05),Chao1指数、Shanonon指数和优杆菌属、粪杆菌属、普雷沃菌属水平相对丰度均低于未发生组(P＜0.05);多因素Logistic回归分析显示,脑出血量、NIHSS评分以及梭菌属、埃希菌属、布劳特菌属、颤杆菌克属、拟杆菌属水平相对丰度升高均是HICH患者PND的危险因素(P＜0.05),Chao1指数、Shanonon指数和优杆菌属、粪杆菌属、普雷沃菌属水平相对丰度升高是其保护因素(P＜0.05)。结论: HICH并发PND患者肠道菌群多样性、丰富度和优杆菌属、粪杆菌属、普雷沃菌属水平相对丰度降低,梭菌属、埃希菌属、布劳特菌属、颤杆菌克属、拟杆菌属水平相对丰度升高,且上述指标异常可增加HICH患者PND的发生风险。

Objective: To observe the changes in gut microbiota in patients with hypertensive intracerebral hemorrhage(HICH), and to analyze their relationship with postoperative neurocognitive disorders(PND). Methods: 237 HICH patients admitted to our hospital from October 2020 to July 2023 were selected, and their gut microbiota was detected. They were divided into a occurrence group and a non-occurrence group according to whether HICH patients developed PND. The changes in gut microbiota and general informations of the two groups were compared, and the relationship between gut microbiota changes and PND in HICH patients was explored. Results: The cerebral hemorrhage volume, National Institutes of Health Stroke Scale(NIHSS) score, and relative abundance levels of Clostridium, Escherichia, Blautia, Oscillibacter and Bacteroidetes genera in the occurrence group were higher than those in the non-occurrence group(P<0.05), while the Chao1 index, Shanonon index and relative abundance levels of Eubacterium, Faecalibacterium and Prevotella were all lower than those in the non-occurrence group(P<0.05). Multivariate Logistic regression analysis showed that cerebral hemorrhage volume, NIHSS score, relative abundance levels of Clostridium, Escherichia, Blautia, Oscillibacter and Bacteroidetes genera were all risk factors for PND in HICH patients(P<0.05), while Chao1 index, Shanonon index, and relative abundance levels of Eubacterium, Faecalibacterium and Prevotella were protective factors(P<0.05). Conclusion: The diversity, richness and the relative abundance levels of Eubacterium, Faecalibacterium and Prevotella are reduced of gut microbiota in HICH with PND patients, while the relative abundance levels of Clostridium, Escherichia, Blautia, Oscillibacter and Bacteroidetes genera are increased, and these indicators can increase the risk of PND in HICH patients.

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