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中华神经创伤外科电子杂志 ›› 2026, Vol. 12 ›› Issue (01) : 30 -38. doi: 10.3877/cma.j.issn.2095-9141.2026.01.005

临床研究

可溶性膳食纤维对重症脑出血患者肠道微生态的影响
冯毅1, 贾耿1, 陈璐2, 秦华平1, 杨常春1, 邵耐远1, 彭亚1,†()   
  1. 1213003　江苏常州，常州市第一人民医院神经外科
    2213003　江苏常州，常州市第一人民医院临床营养科
  • 收稿日期:2024-11-18 出版日期:2026-02-15
  • 通信作者: 彭亚

Effects of soluble dietary fiber on intestinal microecology in patients with severe cerebral hemorrhages

Yi Feng1, Geng Jia1, Lu Chen2, Huaping Qin1, Changchun Yang1, Naiyuan Shao1, Ya Peng1,†()   

  1. 1Department of Neurosurgery, Changzhou First People's Hospital, Changzhou 213003, China
    2Department of Clinical Nutrition, Changzhou First People's Hospital, Changzhou 213003, China
  • Received:2024-11-18 Published:2026-02-15
  • Corresponding author: Ya Peng
  • Supported by:
    Clinical Research Special Fund of Wu Jieping Medical Foundation(320.6750.2022-02-36)
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引用本文：

冯毅, 贾耿, 陈璐, 秦华平, 杨常春, 邵耐远, 彭亚. 可溶性膳食纤维对重症脑出血患者肠道微生态的影响[J/OL]. 中华神经创伤外科电子杂志, 2026, 12(01): 30-38.

Yi Feng, Geng Jia, Lu Chen, Huaping Qin, Changchun Yang, Naiyuan Shao, Ya Peng. Effects of soluble dietary fiber on intestinal microecology in patients with severe cerebral hemorrhages[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2026, 12(01): 30-38.

目的

探讨富含可溶性膳食纤维（SDF）的肠内营养制剂对重症脑出血患者肠道微生态的影响。

方法

前瞻性纳入2023年3月至2024年8月常州市第一人民医院神经外科重症监护室收治的重症脑出血患者为研究对象。采用随机数字表法将患者分为SDF组（接受含SDF的肠内营养制剂）与Non-SDF组（接受不含SDF的肠内营养制剂）。肠内营养干预7 d后采集粪便样本进行宏基因组测序，比较2组患者肠道菌群多样性与组成差异；采用线性判别分析（LEfSe）筛选组间差异菌，随机森林模型评估差异菌的特征重要性，以筛选潜在生物标志物；采用典范对应分析（CCA）法分析菌群与临床指标的相关性。

结果

本组共纳入42例重症脑出血患者，其中SDF组18例，Non-SDF组24例。2组患者肠道菌群α多样性与β多样性比较，差异均无统计学意义（P>0.05）。与Non-SDF组相比，SDF组粪副拟杆菌相对丰度升高（P=0.025），屎肠球菌相对丰度降低（P=0.042）。LEfSe分析显示，在种水平上最终识别到6个判别性生物标志物，其中4个在SDF组中富集，包括粪居拟杆菌、粪副拟杆菌、史氏甲烷短杆菌和戈尔巴奇嗜胨菌；2个在Non-SDF组中富集，包括屎肠球菌和着色霍氏菌。随机森林模型分析显示，粪副拟杆菌在随机森林模型的置换重要性和Gini系数重要性排序中均显示最高重要性。CCA分析显示，狄氏副拟杆菌、脆弱拟杆菌与神经功能损伤及意识水平下降相关，解糖胨普雷沃菌、大肠埃希氏菌与免疫反应及炎症过程相关。

结论

SDF肠内营养干预7 d未显著改变重症脑出血患者肠道菌群整体多样性，但可选择性调节关键菌种丰度，且部分菌种丰度与神经功能/意识状态及免疫炎症指标具有相关性。

关键词: 重症脑出血, 可溶性膳食纤维, 肠内营养, 肠道微生态
Objective

To investigate the effect of enteral nutrition preparations rich in soluble dietary fiber (SDF) on the gut microbiota of patients with severe cerebral hemorrhage.

Methods

Prospective inclusion of severe cerebral hemorrhage patients admitted to the Neurosurgery Intensive Care Unit of Changzhou First People's Hospital from March 2023 to August 2024 as the study subjects. Using a random number table, patients were divided into an SDF group (receiving enteral nutrition preparations containing SDF) and a Non-SDF group (receiving enteral nutrition preparations without SDF). After 7 d of enteral nutrition intervention, fecal samples were collected for metagenomic sequencing to compare the differences in gut microbiota diversity and composition between two groups of patients; Linear discriminant analysis (LEfSe) was used to screen for inter group differential bacteria, and a random forest model was used to evaluate the feature importance of differential bacteria in order to screen for potential biomarkers; canonical correspondence analysis (CCA) was used to analyze the correlation between microbiota and clinical indicators.

Results

A total of 42 patients with severe cerebral hemorrhage were included in this group, including 18 cases in the SDF group and 24 cases in the Non-SDF group. There was no statistically significant difference in the α and β diversity of gut microbiota between the two groups of patients (P>0.05). Compared with the Non-SDF group, the SDF group showed an increase in the relative abundance of Fecal pseudomonas (P=0.025) and a decrease in the relative abundance of Escherichia coli (P=0.042). LEfSe analysis showed that six discriminative biomarkers were ultimately identified at the species level, of which four were enriched in the SDF group, including Bacteroides faecalis, Fecal pseudomonas, Methanobacterium faecalis, and Streptococcus pyogenes; Two were enriched in the Non-SDF group, including Enterococcus faecalis and Vibrio cholerae. Random forest model analysis showed that Fecal pseudomonas had the highest importance in both permutation importance and Gini coefficient importance ranking in the random forest model. CCA analysis showed that Pseudomonas aeruginosa and Bacteroidetes fragilis were associated with neurological damage and decreased levels of consciousness, while Pseudomonas aeruginosa and Escherichia coli were associated with immune response and inflammatory processes.

Conclusions

SDF enteral nutrition intervention for 7 d did not significantly change the overall diversity of gut microbiota in patients with severe cerebral hemorrhage, but it can selectively regulate the abundance of key bacterial species, and some bacterial species abundance is significantly correlated with neurological function/consciousness status and immune inflammatory indicators.

Key words: Severe cerebral hemorrhage, Soluble dietary fiber, Enteral nutrition, Gut microbiota
表1 2组重症脑出血患者基线资料比较
Tab.1 Comparison of baseline data between two groups of severe cerebral hemorrhage patients
项目 SDF组（n=18） Non-SDF组（n=24） χ2/t/Z值 P值
性别[例（%）]     0 1.000
男 12（66.67） 16（66.67）    
女 6（33.33） 8（33.33）    
年龄（岁，±s） 56.56±15.52 58.13±11.98 -0.370 0.713
BMI（kg/m2，±s） 23.64±2.66 24.98±3.35 -1.403 0.168
出血原因[例（%）]     0.203 0.653
高血压脑出血 11（61.11） 13（54.17）    
脑外伤 7（38.89） 11（45.83）    
脑疝[例（%）] 4（22.22） 3（12.50） 0.700 0.403
瞳孔散大[例（%）]     5.231 0.073
否 13（72.22） 22（91.67）    
单侧 5（27.78） 1（4.17）    
双侧 0（0.00） 1（4.17）    
合并高血糖[例（%）] 5（27.78） 12（50.00） 2.108 0.147
使用抗生素[例（%）]     2.159 0.340
否 5（27.78） 3（12.50）    
半合成青霉素 5（27.78） 11（45.83）    
二/三代头孢 8（44.44） 10（41.67）    
手术[例（%）]     1.378 0.502
否 3（16.67） 3（12.50）    
钻孔 7（38.89） 6（25.00）    
开颅 8（44.44） 15（62.50）    
APACHEⅡ评分（分，±s） 13.33±4.85 12.25±3.80 0.812 0.422
NIHSS评分[分，M（Q1，Q3）] 27.5（23.8，29） 26.5（22.3，28） -1.089 0.276
GCS评分[分，M（Q1，Q3）] 6（5，7.3） 6（5，8） -0.286 0.775
平均每日热卡[kcal/（kg·d），M（Q1，Q3）] 1876（1799，2023） 1876（1463，2009） -0.890 0.374
图1 2组重症脑出血患者的肠道菌群多样性分析A~D：α多样性分析；A：Ace指数；B：Chao指数；C：Shannon指数；D：Simpson指数；E~F：β多样性分析；E：PCA分析；F：PCoA分析；SDF：水溶性膳食纤维
Fig.1 Analysis of gut microbiota diversity in two groups of patients with severe cerebral hemorrhage
图2 2组重症脑出血患者肠道菌群物种组成分析A：种水平物种分布韦恩图；B：相对丰度排名前20物种的堆叠柱状图；SDF：水溶性膳食纤维
Fig.2 Analysis of species composition of gut microbiota in two groups of patients with severe cerebral hemorrhage
图3 2组重症脑出血患者肠道菌群差异物种分析A：种水平上丰度差异物种分析；B：LEfSe分析柱状图（物种前的字母代表分类水平：k，界水平；p，门水平；c，纲水平；o，目水平；f，科水平；g，属水平；s，种水平）；C：基于所有物种构建的随机森林模型ROC曲线；D~E：变量置换重要性（D）和基于Gini系数的重要性（E）评估排序图；SDF：水溶性膳食纤维；LEfSe：线性判别分析；ROC：受试者工作特征；AUC：曲线下面积
Fig.3 Species analysis of gut microbiota differences in two groups of patients with severe cerebral hemorrhage
图4 重症脑出血患者临床指标与肠道菌群相对丰度的CCA分析
Fig.4 CCA analysis of clinical indicators and relative abundance of gut microbiota in patients with severe cerebral hemorrhage
表2 临床指标与肠道菌群相对丰度的相关性分析
Tab.2 Correlation analysis between clinical indicators and relative abundance of gut microbiota
菌种 临床指标 r值 P值
解糖普雷沃菌丰度 中性粒细胞计数 -0.38 0.013
  血小板 -0.36 0.019
  白细胞计数 -0.35 0.023
  淋巴细胞比例 0.31 0.043
狄氏副拟杆菌丰度 APACHEⅡ评分 0.41 0.007
  NIHSS评分 0.41 0.008
大肠埃希菌丰度 白细胞计数 0.38 0.013
  中性粒细胞计数 0.38 0.014
  淋巴细胞比例 -0.34 0.027
  降钙素原 -0.34 0.029
脆弱拟杆菌丰度 NIHSS评分 0.35 0.024
  APACHEⅡ评分 0.33 0.031
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