慢性萎缩性胃炎气虚证患者病位证素分布特点与肠道微生态特征OA

Objective:To investigate distribution characteristics of disease location syndrome elements in patients with chronic atrophic gastritis(CAG)of Qi deficiency syndrome and to explore the structural and functional features of their gut microbiota.Meth-ods:A total of 68 CAG patients treated in the Department of Spleen and Stomach Diseases,Jinjiang Hospital of Traditional Chinese Medicine(TCM)Affiliated to Fujian University of TCM from March 2022 to January 2023 were selected as the study subjects.Ac-cording to the TCM syndrome element differentiation method,patients were divided into Qi deficiency syndrome group and a non-Qi deficiency syndrome group for comparative analysis,with 34 cases in each group.The intelligent analysis platform for TCM health status developed by Fujian University of TCM was used to analyze the distribution of disease location syndrome elements in the two groups.Meanwhile,26 healthy subjects from the Physical Examination Center of Jinjiang Hospital of TCM Affiliated to Fujian Uni-versity of TCM were included as a healthy control group.The gut microbiota of the three groups were analyzed using 16S rRNA se-quencing technology:Alpha diversity indices,including community richness indices(ACE,Chao1)and diversity indices(Shannon,Simpson),were calculated;principal coordinate analysis(PCoA)and non-metric multidimensional scaling(NMDS)were used for Be-ta diversity analysis to assess differences in community structure between groups;at the phylum and genus taxonomic levels,the top 10 dominant species by relative abundance were selected to draw bar charts for analyzing species composition;linear discriminant analysis effect size(LEfSe)was used to identify significantly different microbiota between groups;the relative abundance data of core short-chain fatty acids(SCFAs)-producing genera were extracted for inter-group comparison;finally,the PICRUSt2 functional predic-tion algorithm was used to perform KEGG pathway enrichment analysis and statistical analysis of the average abundance of differen-tial metabolic pathways among the three groups.Results:1)Distribution of disease location syndrome elements:in the Qi deficiency syndrome group,the stomach(79.41%)and spleen(52.94%)were the core disease locations,followed by the liver(26.47%),and the frequency of the spleen syndrome element in the Qi deficiency syndrome group was significantly higher than that in the non-Qi defi-ciency syndrome group(P<0.05).2)Microbiota diversity:the ACE,Chao1,and Shannon indices in the Qi deficiency syndrome group were significantly lower than those in the healthy group(P<0.05);the ACE and Chao1 indices in the non-Qi deficiency syndrome group were also lower than those in the healthy group(P<0.05).PCoA and NMDS analyses both showed statistically significant differ-ences in microbiota structure among the three groups(P<0.05).3)Results of species composition analysis at phylum and genus levels and differential microbiota analysis showed that the core microbiota structure of the three groups was generally similar,but the rela-tive abundance of key genera had statistically significant differences between groups(P<0.05).Compared with the healthy group,the relative abundance of SCFAs-producing genera(Roseburia,Blautia)in the Qi deficiency syndrome group significantly reduced(P<0.05),while the relative abundance of Escherichia-Shigella significantly increased(P<0.05).Compared with the Qi deficiency syn-drome group,the relative abundance of Roseburia in the non-Qi deficiency syndrome group significantly increased(P<0.05),while the relative abundance of Escherichia-Shigella decreased(P<0.05).LEfSe analysis further showed that Enterobacteriaceae and Esche-richia-Shigella were significantly enriched in the Qi deficiency syndrome group(P<0.05),while Roseburia was enriched in the non-Qi deficiency syndrome group(P<0.05).4)KEGG pathway analysis and statistical results of the average abundance of differential metabolic pathways showed that the abundance of the''other types of O-glycan biosynthesis''pathway was significantly up-regulated in the Qi deficiency syndrome group,and its average abundance in the Qi deficiency syndrome group was significantly higher than that in the non-Qi deficiency syndrome group and the healthy group(P<0.05).In addition,the"Chloroalkane and chloroalkene degra-dation"pathway was present in both the Qi deficiency syndrome group and the non-Qi deficiency syndrome group,but completely ab-sent in the healthy group,and the difference between groups was statistically significant(P<0.05).Conclusion:The disease location of CAG with Qi deficiency syndrome is primarily in the stomach and spleen.Its gut microbiota characteristics are manifested by re-duced microbial diversity,decreased SCFAs-producing bacteria,and increased pathogenic bacteria.Genera such as Roseburia may serve as biomarkers to assist syndrome differentiation,providing a basis for TCM micro-differentiation and microbiota intervention.