Objective: To investigate the characteristics of gut microbiota in type 2 diabetes mellitus (T2DM) patients with hypertriglyceridemia (HTG). Methods: Eighty-one patients first diagnosed with T2DM were enrolled in the Third Xiangya Hospital of Central South University from January 2018 to December 2020, including 58 patients [46 males and 12 females, aged (43±13) years] with HTG [HTG group, triglyceride (TG)≥1.7 mmol/L]. There were 23 cases without HTG (NTG group), including 20 males and 3 females, aged (46±13) years. According to the severity of HTG, the patients of HTG group were divided into severe HTG group (STG group, TG ≥5.6 mmol/L) and mild HTG group (MTG group, 1.7 mmol/L≤TG<5.6 mmol/L). Thirty healthy controls were matched accordingly, including 21 males and 9 females, aged (45±6) years. Clinical laboratory indicators and feces of the subjects were collected and 16S rRNA sequencing was performed to compare the differences in intestinal flora among the groups. Results: The Shannon and Simpson indexes in HTG group were lower than those in NTG group and healthy control group (5.02±0.91 vs 5.45±0.55 and 5.60±0.63, P=0.003; 0.90±0.06 vs 0.93±0.04, 0.94±0.04, P=0.002). Compared with healthy control group and NTG group, the abundance of intestinal P_Proteobacteria, g_Escherichia_Shigella, s_Escherichia_Coli and g_Clostridium_sensu_stricto_1 increased in HTG group, while the abundance of p_Firmicutes, g_Faecalibacterium and Faecalibacterium_prausnitzii decreased. The abundance of g_Clostridium_sensu_stricto_1 in the STG group was higher than that of NTG and MTG groups, while the abundance of g_Faecalibacterium decreased. Spearman correlation analysis suggested that g_Clostridium_sensu_stricto_1 was positively correlated with glycosylated hemoglobin (r=0.22, P=0.044), fasting blood glucose (r=0.36, P=0.001), TG (r=0.27, P=0.015) and total cholesterol (r=0.44, P<0.001). Logistic regression analysis indicated that g_Faecalibacterium was a protective factor for T2DM with HTG(OR=0.90, 95%CI:0.83-0.97, P=0.006). Conclusions: The intestinal flora of T2DM patients with HTG was dysregulated, which was manifested as decreased diversity, increased abundance of P_Proteobacteria and decreased abundance of p_Firmicutes. g_Faecalibacterium is a protective factor for T2DM with HTG.
目的： 探讨2型糖尿病（T2DM）合并高三酰甘油血症（HTG）患者肠道菌群的特征。 方法： 纳入2018年1月至2020年12月于中南大学湘雅三医院首次诊断为T2DM的患者81例，其中合并HTG者［HTG组，三酰甘油（TG）≥1.7 mmol/L］58例，男46例，女12例，年龄（43±13）岁；未合并HTG者（NTG组）23例，男20例，女3例，年龄（46±13）岁。根据HTG严重程度，HTG组患者又分为重度HTG组（STG组，TG≥5.6 mmol/L）及轻度HTG组（MTG组，1.7 mmol/L≤TG<5.6 mmol/L），同时匹配健康对照者30名，男21名，女9名，年龄（45±6）岁。收集研究对象的临床化验指标及粪便，进行16S rRNA测序，比较各组间肠道菌群的差异。 结果： HTG组患者的Shannon和Simpson指数均低于NTG组和健康对照组（5.02±0.91比5.45±0.55、5.60±0.63，P=0.003；0.90±0.06比0.93±0.04、0.94±0.04，P=0.002）。与健康对照组和NTG组相比，HTG组肠道变形菌门、大肠志贺氏杆菌属、大肠杆菌和狭义梭菌属-1丰度增加；而厚壁菌门、粪杆菌属和普氏栖粪杆菌的丰度下降。与NTG和MTG组相比，STG组肠道菌群中狭义梭菌属-1丰度升高，而粪杆菌属丰度下降。Spearman相关性分析提示狭义梭菌属-1与糖化血红蛋白（r=0.22，P=0.044）、空腹血糖（r=0.36，P=0.001）、TG（r=0.27，P=0.015）和总胆固醇（r=0.44，P<0.001）的水平呈正相关。Logistic回归分析提示粪杆菌属为T2DM合并HTG的保护因素（OR=0.90，95%CI：0.83~0.97，P=0.006）。 结论： 合并HTG的T2DM患者肠道菌群失调，表现为菌群多样性下降，变形菌门丰度升高，厚壁菌门丰度下降。粪杆菌属为T2DM合并HTG的保护因素。.