目的：探讨行胃旁路术（Roux-en-Y gastric bypass， RYGB）的肥胖2型糖尿病（T2DM）患者肠道菌群变化与中间型单核细胞（IM）变化的相关性。方法：选取24例行RYGB手术的肥胖T2DM患者，术前1 d和术后6个月分别抽取静脉血、留取新鲜粪便标本。检测IM百分比、肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）水平、TLR₄蛋白表达阳性率和平均荧光强度（MFI）。RT-PCR法测定粪便标本中目的细菌DNA的含量。用Spearman分析肠道菌群变化与IM变化的相关性。结果：与术前比较，RYGB术后6个月IM百分比显著减少（P<0.05），IM内TNF-α、IL-6水平显著下降（均P<0.05），IM表面TLR₄蛋白表达显著下降（P<0.05）。肠道双歧杆菌数量显著增加（P<0.05），而大肠杆菌的数量显著减少（P<0.05）；大肠杆菌数量与IM内TNF-α表达呈正相关（r=0.442，P<0.05）；大肠杆菌数量与IM表面TLR₄蛋白表达呈正相关（r=0.425，P<0.05）。结论：RYGB术后T2DM患者外周血IM及细胞因子的变化与肠道大肠杆菌数量减少、双歧杆菌增加密切相关，IM、细胞因子、大肠杆菌和双歧可能均参与了T2DM缓解的过程。

[1] QIU N C,ZHANG Q,SONG X,et al.Impact of the hepatic branch of the vagus and Roux-en-Y gastric bypass on the hypoglycemic effect and glucagun-like peptide-1 in rats with type 2 diabetes mellitus[J].J Surg Res,2014,191(1):123-129.
[2] QIU N C,LIU M E,WANG B,et al.Does the hepatic branch of vagus mediate the secretion of glucagon-like peptide-l during the Roux-en-Y gastric bypass surgery[J].J Gastrointestin Surg,2014,18(11):1957-1964.
[3] WANG Z,SHEN X H,FENG W M,et al.Analysis of inflammatory mediators in prediabetes and newly diagnosed type 2 diabetes patients[J].J Diabetes Res,2016:7965317.
[4] WONG K L,TAI J J,WONG W C,et al.Gene expression profiling reveals the defining features of the classical,intermediate,and nonclassical human monocyte subsets[J].Blood,2011,118(5):e16-31.
[5] POITOU C,DALMAS E,RENOVATO M,et al.CD 14dim CD16+ and CD14+CD16+ monocytes in obesity and during weight loss:relationships with fat mass and subclinical atherosclerosis[J].Arterioscler Thromb Vasc Biol,2011,31(10):2322-2330.
[6] KWAK S J,KIM C S,CHOI M S,et al.The Soy peptide phe-leu-val reduces TNFα-induced inflammatory response and insulin resistance in adipocytes[J].J Med Food,2016,19(7):678-685.
[7] HERDER C,FAERCH K,CARSTENSEN-KIRBERG M,et al.Biomarkers of subclinical infiammation and increases in glycaemia,insulin resistance and beta-cell function in non-diabetic individuals:the Whitehall Ⅱ study[J].Eur J Endocrinol,2016,175(5):367-377.
[8] MONTE S V,CARUANA J A,GHANIM H,et al.Reduction in endotoxemia,oxidative and inflammatory stress,and insulin resistance after Roux-en-Y gastric bypass surgery in patients with morbid obesity and type 2 diabetes mellitus[J].Surgery,2012,151(4):587-593.