The Variation Of Gut Microbiota In Cognitive Dysfunction After Stroke And The Influence Of Rehabilitation Intervention

Objective: The 16S rRNA gene sequencing method is used to study the change of gut microbiota in patients with cognitive dysfunction after stroke and the recovery after cognitive rehabilitation intervention;through relavence analysis to analyze the differential flora and stroke risk factors,neurological impairment scores,clinical test indicators,ultrasound and imaging indicators,and differential metabolites,to further explore the relationship between intestinal dysbiosis and cognitive dysfunction after stroke.Method: After discussion and approval by the hospital ethics committee,all subjects entered the trial after signing the informed consent.Strictly according to the established inclusion and exclusion criteria,24 patients with cognitive dysfunction who were hospitalized in the Rehabilitation Department of Sichuan Provincial People’s Hospital from February to December 2020 were included as the experimental group.During the same period,the patients without a history of cardiovascular and cerebrovascular diseases were matched according to age and gender 23 patients examined in our department for other diseases served as a control group.Collect patients’ general information(age,gender,eating habits,BMI,blood pressure),test indicators(glycated hemoglobin,uric acid,homocysteine,blood lipids,CRP)and rehabilitation function assessment scores(modified Barthel index,MMSE,MOCA).Collect fresh feces before treatment intervention and submit them for examination.After collecting the first stool samples,the experimental group began to use conventional medications(lowering blood pressure,regulating fat,nourishing nerves,improving circulation,etc.,excluding antibiotics,probiotics,etc.,which have been confirmed to have an impact on the structure of intestinal flora and its metabolites Drugs)and cognitive function training.Fresh feces were collected again after 4 weeks of treatment and submitted for examination.After treatment intervention,test index collection and rehabilitation function evaluation were performed again.All fecal specimens were subjected to DNA extraction,PCR amplification,and 16S rRNA sequencing.After obtaining relevant gene sequencing information,the microbiological informatics related analysis was completed on the BMK cloud platform.Results: The results of this study showed that compared with the control group,the experimental group had higher hypersensitivity CRP,waist-to-hip ratio,and BMI before treatment,while low-density lipoprotein,high-density lipoprotein,total cholesterol and other indicators were lower.Compared with the control group,there was no statistical difference between high-sensitivity CRP and waist-to-hip ratio,and other indicators improved,but there were still significant differences.The experimental group was compared before and after treatment.The glycosylated hemoglobin,low-density lipoprotein,high-sensitivity CRP,waist-to-hip ratio,and BMI all decreased,and the high-density lipoprotein,MMSE,MOCA and modified Barthel index increased.Binary Logistic regression analysis indicated that waist-to-hip ratio,BMI,and smoking were risk factors for PSCI,and HDL-C was a protective factor.The intestinal flora was analyzed,and there was no significant difference in the Alpha diversity of the intestinal flora abundance(Chao1 and ACE)and diversity(Shannon and Simpson index)in the control group,the experimental group before treatment and after the treatment group.Beta diversity analysis based on Bray Curtis showed that the composition of the gut microbiota of groups A,B,and C was not statistically significant(Adonis Test,p=0.698).LEf Se was used to analyze the significance of differences between groups.When the LDA cutoff value was4.0,the control group was enriched in Peptostreptococcus and Romboutsia,the test group was enriched in Ruminococcus before treatment,and the experimental group was enriched in intestinal Lactobacillus after treatment.Conclusion: The gut microbiota of patients with cognitive dysfunction after stroke develops enterobacteria disorders characterized by increased Firmicutes/Bacteroides ratio and increased Proteobacteria abundance.The abundance of beneficial bacteria such as Romboutsia decreased,and the abundance of potential opportunistic pathogenic bacteria such as Ruminococcus increased.After the intervention of cognitive function training and rehabilitation intervention,the patient’s intestinal microecological disorder was improved,the abundance of Lactobacillus increased,and cognitive function and related clinical indicators were improved.The role of gut microbiota in the occurrence and development of cognitive impairment after stroke and the mechanism of rehabilitation intervention to improve cognition through gut microbiota require in-depth research.