| ObjectiveBased on a large sample of clinical observation,the characteristics and distribution of TCM syndromes in PFCD patients are summarized,providing a basis for standardizing TCM syndromes differentiation and classification of PFCD.To study the association between different TCM syndromes and anxiety and depression as well as intestinal microecology,so as to provide a basis for the treatment of PFCD based on intestinal microecology,and to provide more scientific support for the precision treatment of TCM.MethodsA total of 227 patients with PFCD are enrolled,the basic information and clinical manifestations of the patients are collected.Based on the Guidelines for diagnosis and treatment of Digestive diseases of Traditional Chinese medicine,the criteria for syndrome differentiation of six syndromes are determined to carry out syndrome differentiation of traditional Chinese medicine.The anxiety and depression status of the patients are evaluated by PHQ-9 and GAD-7 scales,so as to to analyze the epidemiological characteristics of anxiety and depression state.Fecal samples of patients are collected for intestinal microflora detection.Patients with four syndrome types with a sample size of more than 20 cases are selected and healthy control group is established,with 20 cases in each group as the standard.The differences of bacterial community structure and diversity are analyzed by 16S r RNA high-flux gene sequencing technology,and to analyze the correlation between different TCM syndromes and intestinal microorganisms.ResultBasic data:This study includ 227 patients with P erianal Fistulizing Crohn’s Disease,including 183 males and 44 females.(male:female=4.15:1),with an average age of(28.05 ±8.753)years old,and patients between 20 and 29 years old accounted for 47.2%of the total number of patients.The duration of the disease is less than 1 year(48.4%),and more than 3 years(40.5%).Analysis of TCM Syndrome Elements:The number of patients with liver depression and spleen deficiency is the largest,accounting for 41.4%;The second is spleen deficiency and dampness resistance,accounting for 24.2%.The proportion of dampness-heat accumulation syndrome,spleen and stomach deficiency cold syndrome and cold dampness-trapped spleen syndrome was 15.8%,13.2%and 3.5%respectively.The lowest proportion is the syndrome of qi stagnation and blood stasis(0.4%),and this study find that 1.3%of syndrome differentiation is Yin deficiency syndrome.Epidemiological characteristics of anxiety and depression:among 227 patients,34.8%are anxious and 45.8%are depressed.Anxiety state:Combined with extraintestinal manifestations(P=0.022,OR=2.443),CDAI≧150(P=0.001,OR=6.05)are the risk factors for anxiety state.Age<20 years and 40-49 years are protective factors for anxiety state.Depressed state:Combined with extraintestinal manifestations(P=0.001,OR=4.243),CDAI≧150(P=0.004,OR=9.58),PDAI>4(P=0.021,OR=2.07)are risk factors for depression.Age<20 years is protective factors for depressed state.Depressive state is mainly distributed in liver depression and spleen deficiency syndrome,accounting for 64.4%.Anxiety is also mainly distributed in liver depression and spleen deficiency syndrome,accounting for 70.9%,indicating the correlation between the syndrome of liver depression and spleen deficiency and the state of anxiety and depression.Correlation analysis of TCM syndrome type and intestinal flora:Alpha diversity analysis:Chao1 index(P<0.05),suggesting that the richness of five groups of bacteria is different;Simpson index(P>0.05)and Shannons index(P>0.05),indicating that there is no significant difference in the diversity of the five groups.Beta diversity analysis:PCoA analysis indicat that there are differences in the composition of microflora between the syndrome type groups and the healthy control group,and the difference of microflora structure between the syndrome type groups is larger than the control group.NMDS analysis indicates that the results of this study are reliable.Analysis of differences in intestinal flora at different levels:1)At the phylum level,compared with the healthy people,the abundance of Proteobacteria,Fusobacteria and Cyanobacteria in each syndrome type group increased(P<0.05),but the abundance of Desulfobacterota decreased(P<0.05).The abundance of Proteobacteria in damp-heat accumulation group is higher than that in liver depression and spleen deficiency syndrome group and spleen and stomach deficiency cold syndrome group(P<0.05).Bacteroidetes in damp-heat accumulation syndrome group are significantly lower than those in other groups(P<0.05).Verrucomicrobiota in spleen deficiency dampness obstruction syndrome group is significantly lower than that in other groups(P<0.05).2)At the genus level,compared with healthy control group,Escherichia-Shigella,Staphylococcus,Ruminococcus_gnavus_group and Lachnoclostridium are significantly increased in liver depression and spleen deficiency syndrome group(P<0.05).Escherichia-Shigella,Staphylococcus,Ruminococcus_gnavus_group,Chloroplast increased significantly in damp-heat accumulation syndrome group(P<0.05).The number of Escherichia-Shigella,Intestinimonas and Ruminococcus_gnavus_group in spleen deficiency dampness obstruction syndrome group is significantly increased(P<0.05).The Enterococcus,Fusobacterium and Ruminococcus_gnavus_group in spleen and stomach deficiency cold syndrome group are significantly increased(P<0.05).The comparison between different syndrome types find that,Escherichia-Shigella is significantly higher in damp-heat accumulation syndrome group than in spleen and stomach deficiency cold syndrome group(P<0.05).The levels of Lachnoclostridium and Staphylococcus in liver depression and spleen deficiency syndrome group are higher than those in spleen deficiency dampness obstruction syndrome group(P<0.05).The Intestinimonas of the group with spleen deficiency dampness obstruction syndrome group is higher than that of the other groups(P<0.05).Bacteroidetes in spleen and stomach deficiency cold syndrome group are significantly higher than those in other groups(P<0.05).Conclusion1.The main TCM syndromes of PFCD include liver depression and spleen deficiency syndrome,spleen deficiency dampness obstruction syndrome,dampness-heat accumulation syndrome,spleen and stomach deficiency cold syndrome,cold dampness trapped spleen syndrome,qi stagnation and blood stasis syndrome are rare.And this study find that 3 patients with syndrome differentiation of Yin deficiency syndrome.2.Combined with extraintestinal manifestations,CDAI≧150 points are the risk factors for anxiety state.Age<20 years and 40-49 years are protective factors for anxiety state.Combined with extraintestinal manifestations,CDAI≧150 points,PDAI>4 points are risk factors for depression.Age<20 years is protective factors for depressed state.3.Compared with the healthy control group,the abundance of Firmicutes and Bacteroidetes decreased in PFCD patients,while Proteobacteria,Fusobacteria and Cyanobacteria increased significantly.The diversity and structural changes of intestinal flora in patients with liver depression and spleen deficiency and damp-heat accumulation syndrome are more significant than other syndromes.Staphylococcus and Lachnoclostridium may be the microbial marker of patients with liver depression and spleen deficiency syndrome.Escherichia-Shigella may be the microbial markers in patients with damping-heat accumulation syndrome group.4.There is a strong correlation between the Liver depression and spleen deficiency and the state of anxiety and depression. |
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