Georgescu Doina, Caraba Alexandru, Ionita Ioana, Lascu Ana, Hut Emil Florin, Dragan Simona, Ancusa Oana Elena, Suceava Ioana, Lighezan Daniel
Department of Internal Medicine I, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Department of Functional Sciences, Discipline of Pathophysiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Int J Womens Health. 2022 Jan 26;14:41-56. doi: 10.2147/IJWH.S342882. eCollection 2022.
Gallstone disease (GSD) represents one of the most frequent digestive disorders, highly reported in female gender. The purpose of the study was to explore the clinical and gut microbiota particularities of female patients with postcholecystectomy syndrome (PCS) and the possible relationship between gut dysbiosis (DB) and abdominal complaints.
In total, 129 female participants: 104 outpatients divided into two equal groups, 52 PCS (+), 52 PCS (-) and 25 healthy controls were consecutively enrolled in this observational study. Patients underwent clinical examination with assessment of pain, bloating, transit disturbances, abdominal ultrasound/computer tomography/magnetic resonance imaging/endoscopic retrograde cholangiopancreatography, upper and lower digestive endoscopies. Laboratory work-ups and stool microbiology assessments were performed for all study participants (patients and controls). Stool microorganisms were identified by matrix-assisted laser desorption ionization - time-of-flight- mass spectrometry and in patients with DB also by next-generation sequencing.
Older age, complicated gallstones disease, associated conditions like diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome were significantly present in PCS (+) group, as well as sedentary lifestyle and diets characterized by a low fiber intake (p<0.0001). PCS (+) patients displayed significant differences related to the incidence and severity of overall gut microbiota DB, decreased H index of biodiversity and the unbalanced Firmicutes/Bacteroidetes (F/B) ratios by comparison to the PCS (-) group (p<0.0001). Strong positive correlations of the severity of overall DB with bloating and the intestinal habit disorders, as well as of F/B ratios to all abdominal symptoms were noted.
PCS in female patients was associated with older age, sedentary lifestyle, specific dietary habits, history of complicated gallstone disease, diabetes mellitus/impaired glucose tolerance and irritable bowel syndrome, as well as gut microbiota particularities. Overall DB and unbalanced F/B ratios were strongly correlated to abdominal complaints.
胆结石病（GSD）是最常见的消化系统疾病之一，在女性中发病率很高。本研究的目的是探讨胆囊切除术后综合征（PCS）女性患者的临床和肠道微生物群特征，以及肠道生态失调（DB）与腹部不适之间的可能关系。
本观察性研究共纳入129名女性参与者：104名门诊患者分为两组，每组52名，分别为PCS（+）组和PCS（-）组，另有25名健康对照者。患者接受了临床检查，评估疼痛、腹胀、排便紊乱情况，进行腹部超声/计算机断层扫描/磁共振成像/内镜逆行胰胆管造影、上消化道和下消化道内镜检查。对所有研究参与者（患者和对照者）进行了实验室检查和粪便微生物学评估。通过基质辅助激光解吸电离飞行时间质谱法鉴定粪便微生物，对于存在DB的患者，还通过下一代测序进行鉴定。
PCS（+）组中年龄较大、患有复杂胆结石病、伴有糖尿病/糖耐量受损和肠易激综合征等相关疾病的情况明显较多，同时久坐不动的生活方式和低纤维摄入的饮食特点也较为显著（p<0.0001）。与PCS（-）组相比，PCS（+）患者在总体肠道微生物群DB发生率和严重程度、生物多样性H指数降低以及厚壁菌门/拟杆菌门（F/B）比例失衡方面存在显著差异（p<0.0001）。观察到总体DB严重程度与腹胀和肠道习惯紊乱之间存在强正相关，以及F/B比例与所有腹部症状之间存在强正相关。
女性患者的PCS与年龄较大、久坐不动的生活方式、特定饮食习惯、复杂胆结石病病史、糖尿病/糖耐量受损和肠易激综合征以及肠道微生物群特征有关。总体DB和失衡的F/B比例与腹部不适密切相关。
