Shi Yan-Ping, Pan Zhang-Lei, Zhang Jing, Xue Ling-Yu, Li Ming-Qiang
Department of Nephrology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an 271000, Shandong Province, China.
Department of Urology, Tai'an Central Hospital Affiliated to Qingdao University, Tai'an 271000, Shandong Province, China.
World J Diabetes. 2025 Aug 15;16(8):108245. doi: 10.4239/wjd.v16.i8.108245.
The specific mechanism of diabetic nephropathy (DN) has not been fully elucidated, and more and more evidence shows that the development of DN is related to intestinal flora imbalance and micro-inflammatory state process, and this mechanism urgently needs to be further clarified by relevant research.
To investigate the correlation between intestinal microbiota dysbiosis, low-grade inflammatory status, renal function impairment, and disease severity in older patients with DN, in order to provide a basis for the prevention and therapeutic intervention of DN.
We enrolled 167 older patients with DN, diagnosed in the Department of Nephrology between June 2020 and June 2023. Eighty-five patients with type 2 diabetes mellitus (without DN) were enrolled to serve as the control group. A one-year follow-up observation was conducted. We compared the differences in gut microbiota composition, levels of inflammatory markers, and renal function indicators between the two groups, and the characteristics of gut microbiota and the changing patterns of inflammatory markers across different stages of disease progression.
In the DN group, the Chao, Ace, and Shannon indices were significantly lower, while the Simpson index was significantly higher than the control group. The relative abundances of and were significantly lower, whereas the relative abundances of , and were significantly higher than those in the control group ( < 0.05). Estimated glomerular filtration rate was positively correlated with the Chao, Ace, and Shannon diversity indices of the gut microbiota, as well as with the relative abundances of , and , and was negatively correlated with the relative abundances of and ( < 0.05). Logistic regression analysis indicated that lower Chao, Ace, and Shannon indices and higher Simpson index were associated with an increased risk of developing DN. After one year of follow-up, patients in the progression group exhibited a significantly greater decrease in Chao, Ace, and Shannon indices and a greater increase in Simpson index than the stable group. The reduction in the relative abundances of and , as well as the increase in and s, were significantly more pronounced in the progression group than in the stable group ( < 0.05). Regression analysis indicated that greater declines in Chao, Ace, and Shannon indices and relative abundance, along with greater increases in Simpson index and relative abundance, were associated with a more rapid decline in renal function.
The onset and progression of DN in older patients with diabetes are closely associated with gut microbiota composition. The more severe the dysbiosis, the lower the abundance of beneficial bacteria and the higher the abundance of harmful bacteria, leading to an increased risk of both DN occurrence and disease progression.
糖尿病肾病（DN）的具体发病机制尚未完全阐明，越来越多的证据表明，DN的发生发展与肠道菌群失调及微炎症状态过程有关，这一机制亟待相关研究进一步阐明。
探讨老年DN患者肠道微生物群失调、低度炎症状态、肾功能损害及疾病严重程度之间的相关性，为DN的预防和治疗干预提供依据。
选取2020年6月至2023年6月在肾内科确诊的167例老年DN患者。选取85例2型糖尿病（无DN）患者作为对照组。进行为期一年的随访观察。比较两组肠道微生物群组成、炎症标志物水平及肾功能指标的差异，以及疾病进展不同阶段肠道微生物群特征和炎症标志物变化模式。
DN组的Chao、Ace和Shannon指数显著低于对照组，而Simpson指数显著高于对照组。[具体菌种名称未给出]的相对丰度显著低于对照组，而[具体菌种名称未给出]的相对丰度显著高于对照组（P<0.05）。估计肾小球滤过率与肠道微生物群的Chao、Ace和Shannon多样性指数以及[具体菌种名称未给出]的相对丰度呈正相关，与[具体菌种名称未给出]的相对丰度呈负相关（P<0.05）。Logistic回归分析表明，较低的Chao、Ace和Shannon指数以及较高的Simpson指数与发生DN的风险增加有关。随访一年后，进展组患者的Chao、Ace和Shannon指数下降幅度显著大于稳定组，Simpson指数升高幅度也更大。进展组中[具体菌种名称未给出]和[具体菌种名称未给出]相对丰度的降低以及[具体菌种名称未给出]和[具体菌种名称未给出]相对丰度的增加显著大于稳定组（P<0.05）。回归分析表明，Chao、Ace和Shannon指数以及[具体菌种名称未给出]相对丰度的更大下降，以及Simpson指数和[具体菌种名称未给出]相对丰度的更大增加与肾功能的更快下降有关。
老年糖尿病患者DN的发生和进展与肠道微生物群组成密切相关。菌群失调越严重，有益菌丰度越低，有害菌丰度越高，导致DN发生和疾病进展的风险增加。
