| ObjectiveThe purpose of this study is to investigate the difference in the abundance of gut microbiota associated with oxalate metabolism between the calcium oxalate stone patients and normal people.Identifying the traditional Chinese medicine constitution of calcium oxalate stone patients,and different treatment will be given to calcium oxalate stone patients according to different constitution,which further clarify the changes in the abundance of targeted intestinal oxalate metabolism-related flora,so as to verify the correlation and effectiveness of intestinal flora of syndrome differentiation and treatment based on the guidance of TCM constitution theory.MethodsThe stool samples were collected not only from the patients with calcium oxalate stone hospitalized in the sixth surgery department of Guangdong Provincial Hospital of TCM,Fangcun branch,but also from the healthy volunteers during December,2018-December,2020.The difference of the abundance of the targeted flora between two groups were detected by QPCR,including Oxalobacter formigenes,Lactobacillus,Bifidobacterium,Enterobacteriaceae.The diagnosis and treatment based on an overall analysis of the illness and the patient’s condition were given to calcium oxalate stone’s patients after classification of TCM constitution.In the end,those The corresponding changes of targeted gut flora were remeasured.Results1.Baseline assessment:A total of 60 subjects were included in the trial,30 in the renal calcium oxalate stone group,including 13 ureteral stone,16 kidney stone,and 1 bladder stone,another 30 in the healthy volunteer group.The overall sample included 31 males(51.7%)and 29 females(48.3%).There was no significant difference between the two groups in baseline demographic characteristics such as gender,age,height,weight(P>0.05),which were comparable.2.Abundance of targeted flora and Oxalate decarboxylase:The abundance of Oxalobacter formigenes(2.735(0.636,62.750)),Lactobacillus(135.600(70.508,233.227)),oxalate decarboxylase mRNA(0.00014(0.00003,0.00054))incalcium oxalate stone group were significantly decreased than the healthy volunteer group(22.008(2.977,903.511)),(228.249(83.421,1164.974)),(0.00074(0.00004,0.18881)),and the comparison between two groups were all P<0.05.On the otherhand,there was no difference in Bifidobacterium,Enterobacteriaceae.3.Distribution of TCM constitution in calcium oxalate stone group:A total of 5 TCM constitution were found,including 10 cases(35.7%)with a single constitution and 18 cases(64.3%)with a combined constitution.Constitution types accounted for 10 cases of damp heat(35.7%),7 cases of phlegm dampness(25.0%),5 cases of yang deficiency(17.9%),4 cases of qi deficiency(14.3%),and 2 cases of congestion(7.1%).4.Remeasured abundance of corresponding intestinal flora:The abundance of Oxalobacter formigenes(71.716(12.680,295.679)),Lactobacillus(368.447(139.162,848.959)),Bifidobacterium(67545.575(38983.190,113858.67))and oxalate decarboxylase mRNA(0.02695(0.00071,0.46909))in therapy group were significantly increased than untreated group(2.735(0.636,62.750)),(135.600(70.508,233.227)),(16344.72(6868.866,37279.33)),(0.00014(0.00003,0.00054)),comparison between groups were P<0.05,but Enterobacteriaceae showed no difference.Conclusion1.In this study,it was found that compared with normal healthy volunteers,the abundance of Oxalobacter formigenes,Lactobacillus and oxalate decarboxylase in patients with calcium oxalate stones were significantly decreased,which confirmed that the intestinal flora was one of important reason,which drives the formation and development of calcium oxalate stones.2.The result of TCM constitution in calcium oxalate stone group is mainly damp and heat,supplemented by phlegm dampness,Yang deficiency,and blood stasis,which is consistent with the pathogenesis of urolithiasis.3.The corresponding targeted flora were retested after treatment,which showed that Oxalobacter formigenes,Lactobacillus,Bifidobacteriumand oxalate decarboxylase mRNA increased significantly compared with untreated group,suggesting that traditional Chinese medicine has a biological basis for preventing kidney calcium oxalate stones. |
