Correlation between Gut Microbiota，Serum ET，PCT Levels with the Severity and Prognosis of Sepsis
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摘要:
目的 探讨脓毒症患者肠道菌群、血清内毒素（ET）、降钙素原（PCT）水平与病情程度、预后的相关性。 方法 选取2016年1月至2022年12月晋城大医院373例脓毒症患者，根据脓毒症病情程度分为脓毒症组（n=261）、脓毒症休克组（n=112）。比较2组一般资料、肠道菌群、血清ET、PCT水平，并比较不同肠道菌群紊乱程度患者血清ET和PCT水平，分析血清PCT、ET水平与脓毒症肠道菌群紊乱程度的关系。统计患者28 d预后，比较死亡与存活患者入院时肠道菌群、血清ET、PCT水平，分析肠道菌群、血清ET、PCT水平预测预后的价值。 结果 脓毒症休克组双歧杆菌、乳酸杆菌计数低于脓毒症组，大肠埃希菌、肠球菌属计数及血清ET、PCT水平高于脓毒症组（P < 0.05）；肠道菌群紊乱程度Ⅲ度患者血清ET、PCT水平高于Ⅱ度、Ⅰ度患者，Ⅱ度患者高于Ⅰ度患者（P < 0.05）；脓毒症患者血清ET、PCT水平与肠道菌群紊乱程度呈正相关（P < 0.05）；死亡患者入院时双歧杆菌、乳酸杆菌计数低于存活患者，肠球菌属、大肠埃希菌计数及血清ET、PCT水平高于存活患者（P < 0.05）；双歧杆菌、肠球菌属、大肠埃希菌、乳酸杆菌、血清ET、PCT预测预后为死亡的曲线下面积（AUC）分别为0.788、0.782、0.787、0.768、0.791、0.776，联合预测的AUC最大，为0.928（P < 0.05）。 结论 脓毒症患者肠道菌群、血清ET、PCT水平与病情程度密切相关，且在预测预后方面具有较好应用价值。 Abstract:Objective To investigate the correlation between the levels of intestinal flora, serum endotoxin （ET）, and procalcitonin （PCT） in patients with sepsis and their disease severity and prognosis. Methods A total of 373 patients with sepsis in Jincheng University Hospital from January 2016 to December 2022 were selected and divided into sepsis group （n=261） and sepsis shock group （n=112） according to the severity of sepsis. The general data, intestinal flora, serum ET and PCT levels were compared between the two groups, and the serum ET and PCT levels were compared among patients with different degrees of intestinal flora disturbance. The relationship between serum PCT and ET levels and the degree of intestinal flora disturbance in sepsis was analyzed.The prognosis of patients for 28 days was statistically analyzed, and the intestinal flora, serum ET, and PCT levels at the time of admission were compared between dead and alive patients to analyze the value of intestinal flora, serum ET, and PCT levels in predicting prognosis. Results Patients in the septic shock group had lower counts of bifidobacteria and lactobacilli compared to the sepsis group, while counts of Escherichia coli, enterococci, as well as serum levels of ET and PCT were higher in the septic shock group. The severity of disruption in gut microbiota was associated with higher serum levels of ET and PCT, with level III patients having higher levels than level II and level I patients. The levels of ET and PCT in septic patients were positively correlated with the severity of disruption in gut microbiota. Upon admission, deceased patients had lower counts of bifidobacteria and lactobacilli compared to surviving patients, while counts of enterococci, Escherichia coli, as well as serum levels of ET and PCT were higher in deceased patients. The predictive value for prognosis of death for bifidobacteria, enterococci, Escherichia coli, lactobacilli, ET, and PCT were 0.788, 0.782, 0.787, 0.768, 0.791, and 0.776 respectively. The combined predictive value had the highest AUC of 0.928. Conclusion The intestinal flora, serum ET, and PCT levels in patients with sepsis are closely related to the severity of the disease and have good application value in predicting prognosis. -
Key words:
- Sepsis /
- Intestinal microbiota /
- Endotoxins /
- Procalcitonin /
- Prognosis
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图 1 肠道菌群、ET、PCT预测预后的ROC曲线
A：肠道菌群、ET、PCT单独预测预后的ROC曲线；B：肠道菌群、ET、PCT联合预测预后的ROC曲线。
Figure 1. ROC curves of gut microbiota，ET，and PCT predicting prognosis
表 1 2组一般资料和肠道菌群、ET、PCT比较[（$ \bar x \pm s $）/n（%）]
Table 1. General information and comparison of gut microbiota，ET，and PCT in two groups [（$ \bar x \pm s $）/n（%）]
项目 脓毒症组（n=261） 脓毒症休克组（n=112） t/χ2 P 性别 1.355 0.244 男 163（62.45） 77（68.75） 女 98（37.55） 35（31.25） 年龄（岁） 49.62±7.83 51.19±8.26 1.746 0.082 体重指数（kg/m2） 23.26±1.87 23.00±1.91 1.223 0.222 基础疾病 1.536 0.464 多发伤 115（44.06） 57（50.89） 恶性肿瘤 90（34.48） 35（31.25） 其他 56（21.46） 20（17.86） 感染部位 0.906 0.924 肺部 152（58.24） 61（54.46） 腹腔 42（16.09） 21（18.75） 泌尿系 35（13.41） 17（15.18） 皮肤软组织 20（7.66） 9（8.04） 其他部位 12（4.60） 4（3.57） 合并症 高血压 35（13.41） 21（18.75） 1.752 0.186 糖尿病 22（8.43） 14（12.50） 1.489 0.222 高脂血症 18（6.90） 13（11.61） 2.282 0.131 肠道菌群 双歧杆菌（logCFU/g） 9.21±1.10 7.02±0.88 18.658 <0.001* 乳酸杆菌（logCFU/g） 8.75±0.92 6.84±0.81 19.030 <0.001* 大肠杆菌（logCFU/g） 10.15±1.38 13.25±1.84 17.911 <0.001* 肠球菌（logCFU/g） 8.31±1.05 10.43±1.29 16.650 <0.001* ET（pg/mL） 9.97±2.13 25.68±5.41 40.255 <0.001* PCT（ng/mL） 1.65±0.51 6.19±1.56 42.123 <0.001* *P < 0.05。 
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表 2 不同肠道菌群紊乱程度患者ET、PCT比较（$ \bar x \pm s $）
Table 2. Comparison of ET and PCT in patients with different degrees of gut microbiota disorder （$ \bar x \pm s $）
组别 n ET（pg/mL） PCT（ng/mL） Ⅰ度 118 10.06±2.18 1.69±0.54 Ⅱ度 149 16.23±3.14 3.36±1.09 Ⅲ度 106 23.05±4.68 5.02±1.53 F 403.972 251.669 P <0.001* <0.001* *P < 0.05。
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表 3 ET、PCT与肠道菌群紊乱程度的相关性
Table 3. Correlation between ET，PCT and the degree of gut microbiota disorder
指标 检验值 ET PCT 肠道菌群紊乱程度 rs 0.604 0.519 P <0.001* <0.001* *P < 0.05。
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表 4 死亡与存活患者肠道菌群、ET、PCT比较（$ \bar x \pm s $）
Table 4. Comparison of gut microbiota，ET，and PCT between deceased and surviving patients （$ \bar x \pm s $）
组别 n 双歧杆菌（logCFU/g） 乳酸杆菌（logCFU/g） 大肠杆菌（logCFU/g） 肠球菌（logCFU/g） ET（pg/mL） PCT（ng/mL） 存活 312 8.54±0.95 8.33±0.84 10.86±1.51 8.49±1.13 14.46±2.68 2.48±0.76 死亡 61 6.70±0.79 6.42±0.73 13.79±1.88 10.64±1.32 25.73±5.69 6.57±1.51 t 14.194 16.573 13.282 13.207 23.994 31.634 P <0.001* <0.001* <0.001* <0.001* <0.001* <0.001* *P < 0.05。
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表 5 肠道菌群、ET、PCT预测预后的价值
Table 5. The predictive value of gut microbiota，ET，and PCT for prognosis
指标 AUC 95%CI 截断值 敏感度（%） 特异度（%） P 双歧杆菌 0.788 0.753～0.820 7.20 logCFU/g 91.84 54.17 <0.001* 乳酸杆菌 0.782 0.747～0.814 6.85 logCFU/g 77.55 69.44 <0.001* 大肠杆菌 0.787 0.753～0.820 13.01 logCFU/g 74.49 71.63 <0.001* 肠球菌 0.768 0.732～0.801 10.07 logCFU/g 69.39 75.20 <0.001* ET 0.791 0.756～0.823 23.67 pg/mL 73.51 71.23 <0.001* PCT 0.776 0.740～0.808 6.08 ng/mL 73.47 70.24 <0.001* 联合预测 0.928 0.905～0.947 − 89.80 82.74 <0.001* *P < 0.05。
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