Characteristics And Correlation Analysis Of Gut Microbiota In Patients With Diabetic Microvascular Complications

Objective:This study will investigate the correlation between bacterial genera and clinical indicators by using real-time quantitative PCR(RT-PCR)to detect the number of 10 bacterial genera in the intestinal tract of patients with diabetic microvascular complications(diabete microvascular complications,DMC),such as Bacteroides,Prevotella,Bifidobacterium spp,Lactobacillus,Faecalibacterium prausnitzii,Enterococcus spp,Eubacterium rectale,Veillonellaceae,Clostridium leptum and Roseburia inulinivorans,explore the correlation between microbiota genera and clinical indexes,and the influencing factors for diabetic microvascular complications,to provide new ideas for early diagnosis and treatment of diseases in the future.Methods:From September 2019 to November 2020,79 patients with type 2diabetes mellitus(T2DM)were hospitalized in Endocrinology Department of Chengde Medical College.According to whether there are microvascular complications,patients were divided into microvascular complications group(MC group,n=47cases)and diabetes mellitus group(DM group,n=32 cases).The general information of the three groups of subjects were recorded,including:gender,age,height,weight,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),diabetes course,smoking history,drinking history,family history of diabetes,hypertension history,use of metformin,use of glucosidase inhibitors,use of insulin,etc.Measure the fasting blood glucose(FBG),hemoglobin A1c(Hb Alc),alanine aminotransferase(AST),alanine aminotransferase(ALT),glutamyl transpeptidase(GGT),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and serum creatinine(CRE)and 2-hour postprandial blood glucose(2h PG).All subjects underwent urine microalbumin/creatinine measurement,free pupil fundus photography and peripheral nerve examination after admission,fundus fluorescein angiography(FFA)was performed to detect suspicious fundus lesions,detection of suspicious peripheral neuropathy by nerve conduction velocity measurement.By using the RT-PCR technique,the number of Bacteroides,Prevotella,Bifidobacterium spp,Lactobacillus,Faecalibacterium prausnitzii,Enterococcus spp,Eubacterium rectale,Veillonellaceae,Clostridium leptum and Roseburia inulinivorans in fecal samples of all the subjects was detected.To analyze and compare the general data and biochemical indexes of the three groups and the differences among the 10 bacterial genera,and to explore the correlation between the 10 bacterial genera and the biochemical indexes of blood glucose,blood lipid,creatinine.Binary Logestic regression was used to investigate the risk factors of diabetic microvascular complications.Results:1 Comparison of two groups of general information and test indicators.1.1 The course of diabetes and the use of insulin increased significantly in MC group compared with DM group(P<0.05).There were no significant difference in sex,age,height,weight,BMI,SBP,DBP,smoking history,drinking history,family history of hypertension,family history of diabetes,use of metformin and glucosidase inhibitor between the two groups(P>0.05).1.2 The CRE increased significantly in MC group compared with the DM group(P<0.05).There was no significant difference in FBG,2h PG,Hb A1 c,TC,TG,HDL-C,LDL-C,AST,ALT,GGT between the two groups(P>0.05).1.3 There was statistical significant difference in bacteroides,Prevotella,Bifidobacterium spp between the three group(P>0.05).There was no significant difference in another bacterial genera between two groups(P>0.05).2 Correlation analysis results of gut microbiota in diabetic microangiopathy patients with biochemical indexes.Spearman correlation analysis,Prevotella was negatively correlated with Hb A1c(r=-0.378,P=0.009),HDL-C(r=-0.309,P=0.034).Bifidobacterium spp was negatively correlated with CRE(r=-0.305,P=0.037).Lactobacillus was negatively correlated with AST(r=-0.292,P=0.046),ALT(r=-0.352,P=0.015).Faecalibacterium prausnitzii was negatively correlated with Hb A1c(r=-0.431,P=0.003).Enterococcus spp was positively correlated FBG(r=0.290,P=0.048),2h PG(r=0.303,P=0.039).Eubacterium rectale was negatively correlated with TG(r=-0.297,P=0.043).Veillonellaceae was positively correlated AST(r=0.294,P=0.045),ALT(r=0.337,P=0.020).Roseburia inulinivorans was negatively correlated with Hb A1c(r=-0.322,P=0.028),FBG(r=-0.334,P=0.022),2h PG(r=-0.356,P=0.014).3 Logistic regression analysis of risk factors for diabetic microvascular complications.Diabetic microvascular complications was used as dependent variable,diabetes duration,use of insulin,CRE,Bacteroides,Prevotella,Bifidobacterium spp were used as independent variables,carried out logistic regression analysis.Result showed that diabetes duration(OR=7.021,95%CI 1.868～26.386)and Bacteroides(OR=1.057,95%CI 1.006～1.111)was an independent risk factor for DMC disease,and Prevobella(OR=0.850,95%CI 0.725～0.997)was an independent protective factor for DMC disease(P<0.05).Conclusion:1 Compared with diabetic microvascular complications complications,the contents of Bacteroides in intestinal tract increased,and the contents of Prevotella and Bifidobacterium spp decreased.2 The blood glucose,blood lipid and creatinine of diabetic patients with diabetic microvascular complications were related to the content of intestinal bacteria,and the intestinal flora may be closely related to the occurrence of diabetic microvascular complications.3 Bacteroides is an independent risk factor for diabetic microvascular complications,and Prevobella is an independent protective factor for diabetic microvascular complications.