聚乙二醇与硫酸盐对IBS-D肠道微生态网络及代谢破坏的差异评估：一项基于双轴映射的二次挖掘研究

Differential Disruption of Gut Microbiome Networks and Metabolism by PEG and Sulfate in IBS-D: A Secondary Data Mining Study Based on Dual-Axis Mapping

摘要: 腹泻型肠易激综合征在肠道微生态失调等多种病理因素的共同作用下，常表现出长期的黏膜高敏状态与临床症状迁延。结肠镜检查是排查该人群器质性病变的必要环节，但研究证实，检查前机械性肠道准备所引发的急性物理冲刷与化学高渗应激，与患者查后胃肠道症状的异常反弹有着重要联系。此外，不同导泻剂对IBS-D患者极其脆弱的微生态共现网络及底层代谢通路的破坏差异，亦缺乏深度的研究。本研究通过纵向混合效应模型与多维网络拓扑学挖掘证实，相较于聚乙二醇的物理剥离，硫酸盐诱发了微生态骨架的去中心化崩塌与发酵代谢流的彻底瘫痪，对患者构成了肠道微生态的“二次打击”。本文就不同肠道准备方式对IBS-D患者肠道微生态的特异性破坏机制进行系统评估，以期为临床工作者制定精准化、个体化的肠镜检查前肠道准备策略提供借鉴，并为后续围内镜期靶向微生态干预研究的开展提供坚实的理论依据。

Abstract: Under the combined effects of multiple pathological factors such as gut microbiota dysbiosis, diarrhea-predominant irritable bowel syndrome frequently presents with chronic mucosal hypersensitivity and prolonged clinical symptoms. Colonoscopy is an essential procedure to rule out organic lesions in this population. However, studies have confirmed that the acute physical flushing and chemical hyperosmotic stress induced by mechanical bowel preparation prior to the examination are significantly associated with an abnormal rebound of gastrointestinal symptoms post-procedure. Furthermore, there remains a lack of in-depth research on the differential destructive effects of distinct laxatives on the extremely fragile microbial co-occurrence network and underlying metabolic pathways in IBS-D patients. By utilizing longitudinal mixed-effects models and multi-dimensional network topology mining, this study demonstrates that, compared to the physical detachment caused by polyethylene glycol, sulfate induces a decentralized collapse of the ecological skeleton and a complete paralysis of the fermentation metabolic flow, thereby constituting a “second hit” to the patients’ gut microbiome. This article systematically evaluates the specific destructive mechanisms of different bowel preparation regimens on the gut microbiota of IBS-D patients, with the aim of providing clinical practitioners with references to formulate precise and individualized bowel preparation strategies before colonoscopy, and laying a solid theoretical foundation for future research on targeted peri-endoscopic microbiome interventions.