目的 探索心力衰竭分期和肠道菌群组成的相关性。方法 选取2018年3月至2018年9月于解放军总医院心血管内科连续入院症状性心力衰竭C或D期（HFCD）患者25例，根据性别年龄匹配心力衰竭B期（HFB）及心力衰竭A期（HFA）患者各25例，收集粪便标本，并使用16SRNA测序，使用Qiime软件（版本1.9.1）及R软件（版本2.15.3）分析比较各组间肠道菌群组成差异。结果 各组间年龄、性别及传统心力衰竭危险因素方面均无显著差异。HFA组在Chao1（P=0.005），OUT（P=0.018）及PD_whole_tree（P=0.011）这3个反应肠道菌群α多样性的指数上显著高于HFC组及D组。虽然HFA组与HFB组，及HFB和HFCD组虽然在组间未观察到统计学差异，但在Chao1，OUT及PD_whole_tree这3个指数上观察到从HFA组到HFB组，HFB组到HFCD组一致的α多样性下降趋势。HFB组噬胆菌属（Bilophia）的相对丰度显著高于HFA组（P=0.011），HFB组的解琥珀酸菌属（Succiniclasticum）（P=0.011）和多尔氏菌属（Dorea）的相对丰度显著低于HFA组。PCoA-Unweighted Unifrac分析显示，在据所有临床因素进行调整之后，根据心力衰竭分期进行的分组的患者之间β多样性存在显著差异（R2=0.073，P＜0.001）。基于KEGG的功能分析发现了一系列与心力衰竭分期有关的差异。结论 心力衰竭的分期和肠道进群组成相关，从心力衰竭A期和B期的患者即开始出现肠道菌群组成的差异，提示肠道菌群的变化可能为心力衰竭进展的原因。

Objective To explore the correlation of heart failure stage and gut flora composition. Methods From March 2018 to September 2018, 25 patients with symptomatic heart failure stage C or D (HFCD) were consecutively admitted to the Department of cardiovascular medicine of PLA General Hospital, and 25 patients with heart failure stage B (HFB) and heart failure stage an (HFA) were matched according to sex and age. Patient stool samples were collected and compared for differences in gut microbiota composition between groups using 16srna sequencing with Q iime software (version 1.9.1) and R software (version 2.15.3) analysis. Results There were no significant differences in age, sex, or traditional risk factors for heart failure between the groups. HFA group in Chao1 (P=0.005), out (P=0.018) and Pd_ whole_ Tree (P=0.011) was significantly higher in the HFC group and D group. Although no statistically significant differences were observed between the HFA and HFB groups and the HFB and HFCD groups, significant differences were observed in Chao1, out, and Pd_ whole_ Tree. These three indices were consistent from the HFA group to the HFB group and from the HFB group to the HFCD group α Decreasing trend in diversity. The relative abundance of biophilia was significantly higher in the HFB group than in the HFA group (P=0.011), and the relative abundances of succiniclasticum (P=0.011) and dorea were significantly lower in the HFB group than in the HFA group. PCoA unweighted UniFrac analysis showed that after adjustment for all clinical factors, there was no significant difference in the presence of β. There was a significant difference in diversity (R2=0.073, P<0.001). KEGG-based functional analysis identified a range of differences related to heart failure staging. Conclusions The composition and function of gut microbiota correlate with heart failure staging. The change in gut microbiota may cause the progression of heart failure.

国家自然科学基金项目(82070468);北京市医院管理中心“登封”计划专项经费资助(DFL20190101)