Clin Lab. 2022 May 1;68(5). doi: 10.7754/Clin.Lab.2021.210836.
Trimethylamine N-oxide (TMAO) serves as a metabolite of intestinal bacteria as well as a urotoxin influencing the prognosis of chronic kidney disease (CKD), which has become a research hotspot in the field of kidney disease. This study preliminarily explored the alternations of the microbial flora and serum TMAO in patients with type 2 diabetes mellitus (T2DM) complicated with diabetic kidney disease (DKD).
Seventeen T2DM patients at the Affiliated Hospital of Zunyi Medical University between September 2018 and February 2019 were included. Among these patients, 8 patients had T2DM complicated with DKD. Eight healthy volunteers constituted the control group. Fresh stool was collected for Illumina sequencing. Based on the sequencing outcomes, the flora diversity and species differences were analyzed. Serum TMAO, cystatin C, urinary albumin/urine creatinine ratios (ACRs), and routine biochemical outcomes were also compared.
The DKD group exhibited a significantly higher TMAO level than the remaining groups. The high-TMAO group had a significantly increased ACR level compared with the low-TMAO group. TMAO positively correlated with the ACR. Compared with the control group, the DKD group exhibited a decreased flora diversity. At the genus level, both the T2DM group and the DKD group showed decreased numbers of Alloprevotella and Megasphaera compared with the control group. The difference in Megasphaera between the DKD group and the control group was significant.
The alternation of the intestinal microbial flora may participate in the development of DKD, and TMAO and chronic inflammation might be important factors for DKD development.
三甲胺 N-氧化物（TMAO）作为肠道细菌的代谢产物和影响慢性肾脏病（CKD）预后的尿毒素，已成为肾脏病领域的研究热点。本研究初步探讨了 2 型糖尿病（T2DM）合并糖尿病肾病（DKD）患者肠道菌群和血清 TMAO 的变化。
纳入 2018 年 9 月至 2019 年 2 月遵义医科大学附属医院的 17 例 T2DM 患者，其中 8 例 T2DM 合并 DKD。8 例健康志愿者为对照组。采集新鲜粪便进行 Illumina 测序。根据测序结果，分析菌群多样性和物种差异。比较血清 TMAO、胱抑素 C、尿白蛋白/尿肌酐比值（ACR）和常规生化指标。
与其余组相比，DKD 组 TMAO 水平明显升高。高 TMAO 组 ACR 水平明显高于低 TMAO 组。TMAO 与 ACR 呈正相关。与对照组相比，DKD 组菌群多样性降低。在属水平上，T2DM 组和 DKD 组的 Alloprevotella 和 Megasphaera 数量均低于对照组。DKD 组与对照组之间 Megasphaera 的差异具有统计学意义。
肠道微生物菌群的改变可能参与 DKD 的发生，TMAO 和慢性炎症可能是 DKD 发生的重要因素。
