背景:肠道菌群(GM)影响肝脏疾病的进展和治疗反应。GM组成是多种多样的,并且与肝脏疾病的不同病因相关。值得注意的是,在肝硬化继发的门静脉高压症(PH)患者中观察到GM改变,乙型肝炎病毒(HBV)感染是中国肝硬化的主要原因。因此,了解GM改变在HBV感染相关PH患者中的作用至关重要。
目的:评估经颈静脉肝内门体分流术(TIPS)放置后HBV相关PH患者的GM改变。
方法:这是一个前瞻性的,观察性临床研究。本研究招募了30名患者(技术成功率为100%)。纳入因HBV感染相关PH而接受TIPS治疗的食管胃静脉曲张破裂出血患者。在TIPS治疗之前和之后一个月获得粪便样本,和GM使用16S核糖体RNA扩增子测序进行分析。
结果:TIPS安置后一个月,8例患者发生肝性脑病(HE)并被分配到HE组;其他22例患者被分配到非HE组。两组之间的门水平的转基因丰度没有实质性差异,无论TIPS治疗(所有,P>0.05)。然而,在TIPS放置之后,结果如下:(1)嗜血杆菌和埃格斯特菌的丰度增加,而厌氧菌,Dialister,Butyricicocus,在HE组中,示波螺旋体下降;(2)埃格赫拉的丰富度,链球菌,和双歧杆菌增加,而在非HE组中,Roseburia和Ruminococus的含量下降;(3)致病性Morganella的成员出现在HE组中,但未出现在非HE组中。
结论:肠道菌群相关协同作用可能预测HBV相关PH患者TIPS放置后HE的风险。预防性微生物组治疗可用于预防和治疗TIPS放置后的HE。
BACKGROUND: Gut microbiota (GM) affects the progression and response to treatment in liver diseases. The GM composition is diverse and associated with different etiologies of liver diseases. Notably, alterations in GM alterations are observed in patients with portal hypertension (PH) secondary to cirrhosis, with hepatitis B virus (HBV) infection being a major cause of cirrhosis in China. Thus, understanding the role of GM alterations in patients with HBV infection-related PH is essential.
OBJECTIVE: To evaluate GM alterations in patients with HBV-related PH after transjugular intrahepatic portosystemic shunt (TIPS) placement.
METHODS: This was a prospective, observational clinical study. There were 30 patients (with a 100% technical success rate) recruited in the present study. Patients with esophagogastric variceal bleeding due to HBV infection-associated PH who underwent TIPS were enrolled. Stool samples were obtained before and one month after TIPS treatment, and GM was analyzed using 16S ribosomal RNA amplicon sequencing.
RESULTS: One month after TIPS placement, 8 patients developed hepatic encephalopathy (HE) and were assigned to the HE group; the other 22 patients were assigned to the non-HE group. There was no substantial disparity in the abundance of GM at the phylum level between the two groups, regardless of TIPS treatment (all, P > 0.05). However, following TIPS placement, the following results were observed: (1) The abundance of Haemophilus and Eggerthella increased, whereas that of Anaerostipes, Dialister, Butyricicoccus, and Oscillospira declined in the HE group; (2) The richness of Eggerthella, Streptococcus, and Bilophila increased, whereas that of Roseburia and Ruminococcus decreased in the non-HE group; and (3) Members from the pathogenic genus Morganella appeared in the HE group but not in the non-HE group.
CONCLUSIONS: Intestinal microbiota-related synergism may predict the risk of HE following TIPS placement in patients with HBV-related PH. Prophylactic microbiome therapies may be useful for preventing and treating HE after TIPS placement.