Regulation of gut microecology in patients with uric acid stone by potassium sodium hydrogen citrate
Objective To examine the impact of potassium sodium hydrogen citrate(PSHC)on the composition of gut microbiota and its metabolites in patients with uric acid stone(UAS).Methods A total of 40 UAS patients were prospectively enrolled at Changshu Hospital Affiliated to Soochow University from December 2021 to August 2023,while 40 non-stone individuals were enrolled during the same period as the non-stone(NS)group.Patients with stones larger than 6 mm in length and those with multiple or difficult-to-remove subrenal calices after surgery received treatment with PSHC.The serum and urine were subjected to biochemical tests,while the stool underwent gene sequencing of 16S ribosomal RNA(rRNA)and determination of short chain fatty acids(SCFAs)content.Data variables were analyzed using SPSS 22.0,Mothur,R language,and Unparse software.Results The levels of creatinine[92.50(30.25)vs.(73.38±16.95)μmol/L,Z=-3.759,P＜0.01]and uric acid[(505.25±104.96)vs.(365.75±91.69)μmol/L,t=6.331,P＜0.01]were significantly higher in the UAS group than in the NS group,while urine pH level[5.50(1.00)vs.6.00(0.50),Z＝-4.194,P＜0.01]was significantly lower in the UAS group than in the NS group.Additionally,there was a decrease observed in the Ace index[(181.25±57.38)vs.212.89(86.10),Z=-3.579,P＜0.01],Chao1 index(180.77±57.16 vs.232.82±58.84,t=3.932,P＜0.01),and Shannon index(2.68±0.51 vs.2.95±0.56,t=2.233,P＜0.05)of intestinal flora diversity in the UAS group when compared to the NS group.The abundances of Bacteroides[478.13(301.40)vs.300.06(204.28),Z＝-2.365,P＜0.05]and Fusobacterium[13.74(99.13)vs.0.42(4.43),Z=-4.344,P＜0.01]were significantly higher in the UAS group than in the NS group,whereas those of Lachnospira[0.24(19.95)vs.9.89(25.19),Z=-2.732,P＜0.01],Parasutterella[0.33(9.66)vs.3.77(17.53),Z=-2.142,P＜0.05],and Bifidobacterium[0.43(1.17)vs.2.12(12.94),Z=-2.719,P＜0.01]were significantly lower in the UAS group than in the NS group.A total of 15 UAS patients underwent PSHC dissolution therapy.After treatment,the uric acid level[(444.67±74.66)vs.(520.67±101.23)μmol/L,t=2.340,P＜0.05],maximum stone diameter[(4.27±1.16)vs.(9.87±3.52)mm,t=5.846,P＜0.01],and average CT value of stones[(399.57±78.27)vs.(501.84±106.90)HU,t=2.990,P＜0.01]exhibited a significant decrease compared to pre-treatment levels.Additionally,urine pH[6.50(0.50)vs.5.00(0.50),Z=-4.608,P＜0.01]demonstrated an elevation post-treatment.After the treatment,the abundances of Fusobacterium[3.98(53.76)vs.20.22(168.62),Z=-2.189,P＜0.05]exhibited a decrease compared to pre-treatment,while those of Lachnoclostridium(48.91±22.41 vs.26.63±18.30,t=-2.436,P＜0.05)and Parasutterella[(35.70±21.93)vs.0.16(16.91),Z=-2.087,P＜0.05]demonstrated an in-crease.The level of butyric acid in stool increased after treatment compared to pre-treatment(1 017.05±438.37 vs.669.94±258.97,t ＝-2.156,P＜0.05).Conclusion UAS patients exhibit distinct intes-tinal microecological characteristics.Administration of PSHC can modulate gut microbiota and metabolites.Targeted regulation of gut microbiota and SCFAs holds great promise for enhancing the efficacy of pharma-cological treatments and preventing stone recurrence.
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