Translational Research Center for Gastrointestinal Disorders (TARGID), University Hospital Leuven, KU Leuven, Leuven, Belgium.
Department Microbiology and Immunology, KU Leuven, Leuven, Belgium.
Gut. 2017 Jan;66(1):79-88. doi: 10.1136/gutjnl-2015-309398. Epub 2015 Sep 30.
Pouchitis is the most common complication after colectomy with ileal pouch-anal anastomosis (IPAA) for UC and the risk is the highest within the 1st year after surgery. The pathogenesis is not completely understood but clinical response to antibiotics suggests a role for gut microbiota. We hypothesised that the risk for pouchitis can be predicted based on the faecal microbial composition before colectomy.
Faecal samples from 21 patients with UC undergoing IPAA were prospectively collected before colectomy and at predefined clinical visits at 1 month, 3 months, 6 months and 12 months after IPAA. The predominant microbiota was analysed using community profiling with denaturing gradient gel electrophoresis followed by quantitative real-time PCR validation.
Cluster analysis before colectomy distinguished patients with pouchitis from those with normal pouch during the 1st year of follow-up. In patients developing pouchitis, an increase of Ruminococcus gnavus (p<0.001), Bacteroides vulgatus (p=0.043), Clostridium perfringens (p=0.011) and a reduction of two Lachnospiraceae genera (Blautia (p=0.04), Roseburia (p=0.008)) was observed. A score combining these five bacterial risk factors was calculated and presence of at least two risk factors showed a sensitivity and specificity of 100% and 63.6%, respectively.
Presence of R. gnavus, B. vulgatus and C. perfringens and absence of Blautia and Roseburia in faecal samples of patients with UC before surgery is associated with a higher risk of pouchitis after IPAA. Our findings suggest new predictive and therapeutic strategies in patients undergoing colectomy with IPAA.
pouchitis 是 UC 患者接受结肠切除和回肠储袋肛管吻合术（IPAA）后最常见的并发症，其风险在手术后的 1 年内最高。发病机制尚不完全清楚，但抗生素的临床疗效提示肠道微生物群起作用。我们假设 pouchitis 的风险可以基于手术前粪便微生物组成来预测。
前瞻性收集 21 例 UC 患者行 IPAA 术前粪便样本，并在 IPAA 后 1 个月、3 个月、6 个月和 12 个月时进行预定的临床随访。采用变性梯度凝胶电泳进行群落分析，随后用定量实时 PCR 进行验证，分析主要微生物群。
术前聚类分析可区分 1 年内发生 pouchitis 和无 pouchitis 的患者。在发生 pouchitis 的患者中，观察到 Ruminococcus gnavus（p<0.001）、Bacteroides vulgatus（p=0.043）、Clostridium perfringens（p=0.011）增加，以及两个 Lachnospiraceae 属（Blautia（p=0.04）、Roseburia（p=0.008）减少。计算了这些 5 种细菌风险因素的综合评分，存在至少 2 种风险因素的敏感性和特异性分别为 100%和 63.6%。
UC 患者术前粪便样本中存在 R. gnavus、B. vulgatus 和 C. perfringens，以及缺乏 Blautia 和 Roseburia 与 IPAA 后 pouchitis 的风险增加相关。我们的发现为接受结肠切除和 IPAA 的患者提供了新的预测和治疗策略。
