Characteristics Of Gut Microbiota And Its Metabolites Short Chain Fatty Acids In Patients With Post-stroke Cognitive Impairment And Effects Of Rehabilitation Intervention

Objective: By detecting the gut microbiota and its metabolite short chain fatty acids(SCFAs)in healthy people and post-stroke cognitive impairment(PSCI),to explore the characteristics of gut microbiota and its metabolite SCFAs in patients with PSCI;By comparing the changes of cognitive function score,gut microbiota and its metabolite SCFAs in patients with PSCI before and after rehabilitation intervention,to study the relationship between gut microbiota and its metabolite SCFAs and cognitive function in patients with PSCI,and to explore the mechanism of cognitive dysfunction in patients with PSCI and the new direction of rehabilitation treatment.Methods: A total of 39 subjects were included,of which 20 patients with PSCI hospitalized in the Rehabilitation Department of Sichuan Provincial People’s Hospital from February 2020 to December 2020 were selected as the PSCI group in strict accordance with the inclusion and exclusion criteria,and19 healthy people in our hospital were matched as the control group in the same period.This study is divided into two parts.The first part: The demographic data,clinical test indexes,Montreal cognitive assessment scale and fresh fecal samples of the control group and PSCI group were collected.16 S r RNA was used to determine the DNA of gut microbiota in fecal samples;The content of SCFAs(acetic acid,propionic acid,butyric acid,isobutyric acid,valeric acid,isovaleric acid and caproic acid)in fecal samples was determined by GC-MS.The second part: The patients in PSCI group were given rehabilitation intervention for 4 weeks.After 4 weeks,the clinical test indexes and fresh fecal samples were collected again,and evaluated by Montreal cognitive assessment scale.Thirdly,16 S r RNA was used to determine the DNA of gut microbiota in fecal samples;The qualitative and quantitative determination of SCFAs(acetic acid,propionic acid,butyric acid,isobutyric acid,valeric acid,isovaleric acid and caproic acid)in fecal samples was determined by GC-MS.The correlation between the bacteria and SCFAs with significant differences before and after rehabilitation intervention and the score of Montreal Cognitive Assessment(Mo CA)was analyzed.Result:The first part: 1 Compared with the control group,Mo CA,HDL-C,L DL-C and TC in the PSCI group were lower,while the Hs-CRP was hig her,and the difference of other indexes was not statistically significant.2The analysis of gut microbiota showed that the gut microbiota in PSCI g roup was disordered,and the relative abundance of Escherichia,Ruminoco ccus and Enterococcus was higher,while the abundance of Bacteroides,St reptococcus,Blautia,Subdoligranulum and Eubacterium was lower;Linear d iscriminant analysis effect size(LEf Se)was used to analyze the significa nce of inter group differences based on the genus level.When the bound ary value of Latent Dirichlet Allocation(LDA)was 3.5,the different bac teria in the two groups were Lactobacillus,Veillonella and Romboutsia.3Determination of gut microbiota metabolite SCFAs found that the concent ration of acetic acid,propionic acid,butyric acid and total short chain fa tty acids decreased significantly in PSCI group.The second part: 1 After rehabilitation intervention,the score of montreal cognitive assessment scale increased,while the MAP,Hs-CRP,and BMI were decreased.There was no significant difference in other indexes.2 After rehabilitation intervention,the cognitive function of PSCI patients was improved,the gut microbiota disorder was improved,and the relative abundances of Bifidobacterium,Akkermansia,Blautia,and Subdoligranulum showed an upward trend.The relative abundances of Escherichia,Klebsiella and Enterococcus showed a downward trend;LEf Se was used to analyze the significant differences between groups based on the genus level.When the LDA boundary value was 3.5,the enrichment of Rumenococcus,Haemophilus and Veillonella disappeared after rehabilitation intervention in PSCI patients.3After rehabilitation intervention,the concentrations of acetic acid,propionic acid,butyric acid and total short-chain fatty acids increased in PSCI patients.4The correlation between the bacteria and SCFAs with significant differences before and after rehabilitation intervention and the score of Montreal Cognitive Assessment(Mo CA)was analyzed.The results showed that MOCA score was negatively correlated with Ruminococcus and positively correlated with butyric acid.Conclusion:1 Compared with healthy people,the gut microbiota of PSCI patients has both increased or decreased pathogenic bacteria and increased or decreased beneficial bacteria,and Lactobacillus and Veillonella are enriched;The microbiota was deficient in short-chain fatty acids,especially the concentrations of acetate,propionate,and butyrate.2 After rehabilitation intervention,the cognitive function of PSCI patients was improved,the relative abundance of beneficial bacteria in the gut increased,the relative abundance of pathogenic bacteria decreased,and the enrichment of Ruminococcus,Haemophilus and Veillonella disappeared;The concentrations of acetic acid,propionic acid,butyric acid and total short chain fatty acids increased.3 The gut microbiota and its metabolites short chain fatty acids,especially butyric acid and Ruminococcus,may participate in the changes of cognitive function in the rehabilitation intervention of PSCI patients.