肠道菌群分布与肛周脓肿术后中长期复发的相关性研究:一项单中心五年随访研究OA

Objective To investigate the relationship between intestinal flora distribution and medium-and long-term recurrence after perianal abscess surgery.Methods Clinical data of 128 pa-tients with perianal abscess admitted to Xi'an Traditional Chinese Medicine Hospital from January 2017 to February 2019 were retrospectively collected.According to the recurrence status during follow-up,the patients were divided into recurrence group and non-recurrence group.General data of the two groups were collected.The 5-year recurrence rate of patients after perianal abscess surgeiy was recorded.Abscess fluid samples from patients were cultured,and pathogenic bacteria were identified through drug sensitivity tests.Polymerase chain reaction and high-throughput sequencing were employed to determine the relative abundance of pathogenic bacteria in fecal specimens of the two groups,and Alpha diversity data analysis was conducted.Multivariate Cox regression analysis was used to explore the influencing factors of recurrence after perianal abscess surgery.Results All 128 patients with perianal abscess were discharged smoothly after surgical treatment.The patients were followed up for recurrence for 60 months.Among them,37 cases had recurrence,and 91 cases had no recurrence.The 5-year cumulative disease-free survival rate of patients after surgery was 71.09％,and the recurrence rate was 28.91％.A total of 128 strains of pathogenic bacteria(only one strain of the main pathogen was counted for each patient)were detected and included in the a-nalysis from the abscess fluid specimens of the 128 patients with perianal abscess,including 77 strains(60.16％)of intestinal-derived pathogenic bacteria and 51 strains(39.84％)of non-intes-tinal-derived pathogenic bacteria.In the recurrence group,there were 60 strains of intestinal-derived pathogenic bacteria,and 17 strains in the non-recurrence group;in the recurrence group,there were 26 strains of non-intestinal-derived pathogenic bacteria,and 25 strains in the non-recurrence group,with a statistically significant difference(P=0.001).The Shannon index of intestinal mi-crobial diversity in the recurrence group was lower than that in the non-recurrence group.At the ge-nus level of intestinal pathogenic bacteria,the abundances of Escherichia,Enterobacter,Clostridi-um,and Enterococcus in the recurrence group were significantly higher than those in the non-recur-rence group(P＜0.05).The incidences of concurrent diabetes,high-level abscess,and ratio of patients with multiple surgical incisions in the recurrence group were significantly higher than those in the non-recurrence group(P＜0.05).Cox regression analysis showed that an increase in the in-testinal flora Alpha index was an independent protective factor for recurrence in patients with peri-anal abscess(HR=0.573,95％CI,0.227 to 0.997);while multiple surgical incisions(HR=1.972,95％CI,1.179 to 2.684),intestinal-derived pathogenic bacteria(HR=2.186,95％CI,1.112 to 4.300),an increase in the relative abundance of Escherichia(HR=2.134,95％CI,1.040 to 4.380),an increase in the relative abundance of Clostridium(HR=1.850,95％CI,1.115 to 4.380),and an increase in the relative abundance of Enterobacter(HR=1.679,95％CI,1.035 to 2.725)were independent risk factors for recurrence in patients with perianal abscess.Conclusion The richness and diversity of intestinal flora in patients with perianal abscess are re-duced.Intestinal flora dysbiosis is associated with postoperative recurrence.An increase in the rela-tive abundances of intestinal-derived pathogenic bacteria such as Escherichia coli,Enterobacter cloa-cae,and Enterobacter aerogenes,as well as multiple surgical incisions,are risk factors for postopera-tive recurrence in patients with perianal abscess.