Correlation between pancreatic exocrine insufficiency and intestinal microecology and serum inflammatory index levels in chronic pancreatitis
Objective To explore the correlation between pancreatic exocrine insufficiency and changes in intestinal microbiota and serum inflammatory indicators in patients with chronic pancreatitis(CP).Methods A total of 178 CP patients were selected in the Cangzhou Central Hospital From January 2019 to May 2021 and were divided into no exocrine insufficiency group[faecal elastase 1(FE1)≥200 μg/g,n=40],mild-moderate exocrine insufficiency group(100 μg/g≤FE1＜200 μg/g,n=60)and severe exocrine insufficiency group(FE1＜100 µg/g,n=78)according to whether or not they were accompanied by exocrine insufficiency.The differences in intestinal flora,small intestinal bacterial overgrowth,and serum procalcitonin(PCT),C-reactive protein(CRP),tumour necrosis factor-α(TNF-α)levels were compared among the groups.The correlation between FE1 and intestinal flora,inflammatory factors were analyzed by Spearman correlation analysis.Results The relative abundance of Enterobacteriaceae and Enterococcaceae in patients in the severe exocrine insufficiency group[(0.032±0.004),(0.049±0.011)]were significantly higher than those in the mild-moderate exocrine insufficiency group[(0.024±0.003),(0.036±0.008)]and no exocrine insufficiency group[(0.011±0.001),(0.020± 0.005)],and the relative abundance of Bifidobacteriaceae and Lactobacillaceae[(0.012±0.002),(0.015±0.002)]were significantly lower than those in the mild-moderate exocrine insufficiency group[(0.025±0.006),(0.020±0.004)]and no exocrine insufficiency group[(0.046±0.009),(0.031±0.006)],and the differences were statistically significant(all P＜0.05);the relative abundance of Enterobacteriaceae and Enterococcaceae in patients in the mild-moderate exocrine insufficiency group were significantly higher than that in the no exocrine insufficiency group,the relative abundance of Bifidobacteriaceae and Lactobacillaceae were significantly lower than that of the no exocrine insufficiency group,and the differences were statistically significant(all P＜0.05).The positive rate of small intestinal bacterial overgrowth in the severe exocrine insufficiency group(64.1％)was higher than that in the mild-moderate exocrine insufficiency group(30.0％)and no exocrine insufficiency group(10.0％),and the differences were statistically significant(both P＜0.05);the positive rate of small intestinal bacterial overgrowth in the mild-moderate exocrine insufficiency group was higher than that in the no exocrine insufficiency group,and the difference was statistically signifiicant(P＜0.05).The levels of PCT,CRP and TNF-αin the severe exocrine insufficiency group[(5.8±0.9)ng/L,(245.8±15.0)mg/L,(593.1±41.9)μg/mL]were higher than those in the mild-moderate exocrine insufficiency group[(4.3±0.6)ng/L,(201.0±13.8)mg/L,(512.5±35.6)μg/mL]and no exocrine insufficiency group[(3.1±0.4)ng/L,(183.4±11.2)mg/L,(462.5±28.9)μg/mL],and the differences were statistically significant(all P＜0.05);the levels of PCT,CRP and TNF-α in the mild-moderate exocrine insufficiency group were higher than those in the no exocrine insufficiency group,and the differences were statistically significant(all P＜0.05).The levels of PCT,CRP,TNF-α,Enterobacteriaceae,Enterococcaceae,and positive rate of small intestinal bacterial overgrowth were all negatively correlated with FE1(r=-0.425,-0.518,-0.503,-0.619,-0.507,-0.511;all P＜0.05);while Bifidobacteriaceae and Lactobacillaceae were positively correlated with FE1(r=0.592,0.628;both P＜0.05).Conclusions The small intestinal bacteria in patients with CP exocrine insufficiency overgrow,and intestinal probiotics were reduced,while harmful bacteria were increased,and the body's inflammatory indicators were increased.This might provide a favorable basis for the diagnosis and treatment of patients with CP exocrine insufficiency.
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