AJG: 肠道微生物特异性变化促进克罗恩病复发

2019-07-14 不详 MedSci原创

克罗恩病(CD)是一种慢性复发性肠道炎症性疾病,一般不可预测其复发过程。微生物环境失调经常在CD患者中发生; 然而,缓解期CD患者中的微生物动力学是否有助于增加复发的风险仍然未知,因此,本项研究旨在探究这二者之间的关系。

背景及目的:
克罗恩病(CD)是一种慢性复发性肠道炎症性疾病,一般不可预测其复发过程。微生物环境失调经常在CD患者中发生; 然而,缓解期CD患者中的微生物动力学是否有助于增加复发的风险仍然未知,因此,本项研究旨在探究这二者之间的关系。

方法:
研究人员分析了2年内缓解期CD(45例,217个样本)患者的前瞻性观察队列中微生物组成的长期动态变化,直至发生临床复发,目的是确定微生物组的变化是否先于临床并预测临床复发。机器学习被用于优先考虑在静止阶段区分复发者和非复发者的微生物和临床因素。

结果:
与健康对照组相比,临床,生物标志物和粘膜缓解的CD患者显示微生物丰富度显着降低,生态失调指数增加。在45例静息CD患者中,12例(27%)在随访期间发作。在复发之前的静止患者中的样品显示出Christensenellaceae和S24.7的丰度显着降低,并且与整个缓解期相比,Gemellaceae的丰度增加。值得注意的是,静止阶段个体化微生物不稳定性增加与后续复发风险增加有关(风险比:11.32, 95%CI:3-42,P= 0.0035)。

讨论:
静息CD中个体化的微生物变异显着增加了未来复发的风险,并可能提供指导个性化抢先治疗强化的模型。

原始出处:
Braun,Tzipi MS. Et al. Individualized Dynamics in the Gut Microbiota Precede Crohn's Disease Flares. American Journal of Gastroenterology.2019.

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    2019-11-03 minzju5052