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造血細胞移植患者の口腔常在微生物叢の破綻と非口腔常在細菌の検出

奥, 菜央理 OKU, Saori オク, サオリ 九州大学

2020.09.25

概要

造血細胞移植 (移植) 患者は、移植前処置で大量化学療法や全身放射線治療を受け、重度の骨髄抑制状態となる。その期間、感染症予防として複数の抗生剤投与を受けており、口腔細菌叢へ影響を与えている可能性があるが、移植患者の口腔細菌叢については明らかになっていない。

本研究では、九州大学病院血液・腫瘍・心血管内科にて移植治療を受けた 45 名に対し、移植日当日に舌苔の採取を行った。DNA を抽出後、細菌共通配列であるプライマー8F、338R を用いて 16S rRNA領域 (V1-V2 領域) の遺伝子を網羅的に増幅、細菌構成を明らかにし、地域在住の健常成人 164 名との多様性の比較を行なった。さらに、PacBio Sequel にて全領域の遺伝子を増幅し、移植患者特有の細菌種の特定を行なった。

その結果、移植患者の移植日の口腔細菌叢の多様性は、地域在住成人と比べて有意に低下していたことが明らかになった。また、地域在住成人で優勢である Streptococcus, Prevotella, Neisseriaが有意に低下していた。さらに、移植患者では 34 菌種が口腔外由来であり、中でも Ralstonia pickettii 検出の 13 名中 9 名 (69.2%, P<0.05 Fisher’s exact test)、Staphylococcus haemolyticus検出の 8 名中 7 名 (87.5%, P<0.05 Fisher’s exact test) は死亡しており、これらの 2 菌種を移植日当日に所有していた患者は有意に死亡率が高かった。このことから、移植患者の移植日当日の口腔細菌叢の多様性は低下しており、特異的な細菌叢に変化している可能性が示唆された。

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