急性缺血性卒中患者肠道菌群与中医证候类型的关系初探

观察缺血性卒中后不同中医证候类型患者肠道菌群的组成与结构，寻找不同证候类型与肠道菌群之间的关系，并初步探索各中医证候类型可能存在的特征菌属。

本研究共纳入首发急性缺血性卒中患者17名，并基于缺血性中风证候要素诊断量表与中风病中医诊断标准对患者进行中医证候类型分类，依次分为痰热腑实风痰上扰组、风痰瘀血痹阻脉络组、肝阳暴亢风火上扰组、气虚血瘀组、阴虚风动组。同时选择同期的健康体检者5名作为对照组。分别记录研究对象基本信息，采集粪便样本运用16S rRNA基因高通量测序技术对患者粪便样本中肠道菌群进行OTUs（operational taxonomic units）聚类，并根据结果进行多样性分析和差异性分析。

急性缺血性卒中不同中医证候类型患者与健康体检者在年龄和BMI上差异均无统计学意义（均P＞0.05）。各组对象肠道菌群Chao指数和Shannon指数差异均无统计学意义（均P＞0.05）。痰热腑实风痰上扰组患者独有菌属高达133种；对照组次之，达127种；而阴虚风动组、风痰瘀血痹阻脉络组、肝阳暴亢风火上扰组、气虚血瘀组的独有菌属数量依次为94种、32种、18种、8种。痰热腑实风痰上扰组患者的特征菌属为Anaerotruncus，气虚血瘀组的特征菌属为Megasphaera（巨球菌属），阴虚风动组的特征菌属为Pyramidobacter。

本研究初步显示不同中医证候类型的急性缺血性卒中患者与健康人群有着不同的肠道菌群构成，各证型患者肠道菌群丰度与多样性无显著差异。急性缺血性卒中患者中医证候类型与肠道菌群的组成存在相关性，其中痰热腑实风痰上扰证患者与其他各证患者之间菌群组成差异最大，其特征菌属为Anaerotruncus。

Relationship between traditional Chinese medicine syndrome and intestinal microflora in acute ischemic stroke patients

ObjectiveTo observe the composition and structure of intestinal flora in patients with multiple traditional Chinese medicine (TCM) syndromes after acute ischemic stroke (AIS), find links between different TCM syndromes and flora, and explore possible characteristic genera of each TCM syndrome. MethodsThe patients were classified into TCM syndromes based on diagnostic scale for syndrome elements of ischemic stroke and TCM diagnostic criteria for stroke, and divided into the phlegm-heat fu-organ excess and wind-phlegm invading upward group, wind-phlegm and blood stasis syndrome group, liver-hyperactivity and wind-fire upheaval group, qi deficiency associated blood stasis group, and yin-deficiency and wind stirring group. A total of 17 patients with an initial AIS were included, the information was recorded, and stool samples were collected. OTUs (operational taxonomic units) clustering of intestinal flora in patients' stool samples was performed using 16S rRNA gene sequencing technology. Diversity analysis and difference analysis were performed based on the results. ResultsThere were no statistical differences in age and BMI between AIS patients and controls (all P＞0.05), nor in the Chao index and Shannon index between the groups (all P＞0.05). The number of unique genera for phlegm-heat fu-organ excess and wind-phlegm invading upward syndrome was up to 133 species, followed by the control group with 127 species; the numbers of unique genera for yin-deficiency and wind stirring syndrome, wind-phlegm and blood stasis syndrome, liver-hyperactivity and wind-fire upheaval syndrome, and qi deficiency and blood stasis syndrome were 94, 32, 18 and 8 species, respectively. Anaerotruncus was the characteristic genus for the phlegm-heat fu-organ excess and wind-phlegm invading upward syndrome; Megasphaera was the characteristic genus for the qi deficiency and blood stasis syndrome; Pyramidobacter was the characteristic genus for the yin-deficiency and wind stirring syndrome. ConclusionPatients with different syndromes and healthy individuals have different intestinal flora composition, and there were no significant differences in the abundance and diversity of intestinal flora among syndromes. There was a correlation between the TCM syndromes of AIS and the intestinal flora, with the greatest difference in the composition of flora between patients with phlegm-heat fu-organ excess and wind-phlegm invading upward syndrome and other syndromes, with the characteristic genus being Anaerotruncus.