造血干细胞移植患者肠道菌群改变与移植后营养指标及腹泻的相关性分析OA

Objective To analyze the dynamic changes in gut microbiota before and after hematopoietic stem cell transplantation(HSCT)and explore their correlation with nutritional indicators and diarrhea.Methods Patients who underwent HSCT at Renji Hospital,Shanghai Jiao Tong University School of Medicine,between July 2023 and December 2024 were enrolled.Fecal samples were collected within one month prior to transplantation and 14 days post-transplantation for 16S ribosomal ribonucleic acid(16s rRNA)gene sequencing.Nutritional indicators(anthropometric measurements,dietary intake,and blood biochemical markers)were recorded peri-transplantation.Stool frequency and consistency(assessed using the Bristol Stool Scale)were monitored in 14 days post-transplantation,with diarrhea defined as ≥3 loose or watery stools per day.The age,gender,and primary diagnosis,and transplantation type were obtained from medical records.Alpha and beta diversity analyses were used to compare gut microbiota changes.Multiple testing correction was applied to the research results when necessary,with a false discovery rate(FDR)＜0.05(Q＜0.05)considered statistically significant.Spearman correlation analysis was performed to assess the association between gut microbiota,nutritional indicators,and diarrhea.Results A total of 63 patients(35 males and 28 females)with a median age of 53 years[interquartile range(IQR):46 years,60 years]were included.The diagnoses included multiple myeloma(n=36),non-Hodgkin lymphoma(n=15),and other hematologic diseases(n=12).The incidence of early post-transplant diarrhea was 84.1％,with a median duration of 5 days(IQR:3,7 days).Post-transplant declines were observed in body mass index(BMI),waist circumference,calf circumference,handgrip strength,dietary intake,albumin,and prealbumin(all P＜0.05),while white blood cell count,absolute neutrophil count,and C-reactive protein levels increased(all P＜0.05).Significant reductions in alpha diversity indices(pre-vs.post-HSCT:Sobs index:48.76±16.06 vs.29.98±19.53;Shannon index:2.15±0.59 vs 1.22±0.83;Simpson index:0.23±0.16 vs 0.51±0.30;all Q＜0.001)were observed post-transplantation,along with altered beta diversity(R2=0.11,P=0.001).Clostridium butyricum positively correlated with white blood cell count(r=0.34,P＜0.01),absolute lymphocyte count(r=0.28,P=0.03),absolute neutrophil count(r=0.28,P=0.03),and diarrhea duration(r=0.26,P=0.04),but negatively correlated with BMI(r=-0.30,P=0.02).Bacteroides thetaiotaomicron showed negative correlations with BMI(r=-0.27,P=0.04)and diarrhea duration(r=-0.28,P=0.03),while uncultured_bacterium_g_[Ruminococcus]_gnavus_group was negatively associated with handgrip strength(r=-0.29,P=0.03).Conclusion HSCT significantly alters gut microbiota composition,which correlates with nutritional indicators and diarrhea during early post-transplantation.These findings suggest that microbiota-guided nutritional interventions,such as specific probiotics supplementation,have potential to improve gut function and clinical outcomes in HSCT patients.