肝硬化消化道出血患者经颈静脉肝内门体分流术前后肠道微生态的宏基因组学分析  

Metagenomics analysis of intestinal microbiota in patients with liver cirrhotic gastrointestinal bleeding before and after transjugular intrahepatic portosystemic shunt

作　　者：王玉琳 王中华 刘子文 吕梦鑫 于源滋 李涛 胡锦华 张小茜 Wang Yulin;Wang Zhonghua;Liu Ziwen;Lyu Mengxin;Yu Yuanzi;Li Tao;Hu Jinhua;Zhang Xiaoqian(Department of Gastroenterology,Affiliated Hospital of Shandong Second Medical University,Weifang 261000,China;Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250000,China)

机构地区：[1]山东第二医科大学附属医院消化内科,山东潍坊261000 [2]山东第一医科大学附属省立医院消化内科,济南250000

出　　处：《中华消化病与影像杂志(电子版)》2025年第2期135-143,共9页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

基　　金：山东省自然科学基金(ZR2020MH053,ZR2022LSW004)。

摘　　要：目的比较肝硬化消化道出血患者经颈静脉肝内门体分流术(TIPS)术前、术后肠道微生态结构与功能的特征性变化。方法选取2020年1月至2024年1月收治20例肝硬化消化道出血患者,采集TIPS术前、术后粪便样本,选取20例健康志愿者的粪便样本作为对照进行宏基因组学分析,进一步对测序结果进行物种及功能的注释,分析其差异菌群、代谢通路以及相关性。结果肝硬化消化道出血患者相较于健康对照组,肠道菌群丰度与功能多样性呈现偏低态势。TIPS术前术后两组样本的α多样性无统计学差异(P>0.05),三组比较β多样性有统计学差异(P<0.05)。研究初步发现TIPS术后肠杆菌科的丰度降低,B/E值相应增加,逆转了肝硬化所致B/E比值的下降趋势,进而提升肠道细菌的定植抵抗力;碳水化合物代谢方面,肠道微生物群倾向性由更有效分解碳水化合物的拟杆菌属向利用植物性碳水化合物的普雷沃菌属转变;脂肪代谢方面,肠道产丁酸盐瘤胃球菌属丰度降低。结论TIPS术后患者肠道菌群结构及功能注释有明显的差异,这可为预防和治疗TIPS术后并发症提供潜在的微生态角度新策略。Objective To compare the characteristic changes in the structure and function of the intestinal microbiota in patients with liver cirrhotic gastrointestinal bleeding before and after transjugular intrahepatic portosystemic shunt(TIPS).Methods A total of 20 patients with cirrhotic gastrointestinal bleeding admitted to the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2020 to January 2024 were selected.Fecal samples before and after TIPS were collected,and fecal samples from 20 healthy volunteers were selected a as controls for metagenomic analysis.Subsequently,species and function annotations were conducted on the sequencing results,the differential flora,metabolic pathways and their correlation were analyzed.Results Compared with the healthy control group,patients with cirrhotic gastrointestinal bleeding showed a lower trend in the abundance and functional diversity of gut microbiota.There was no statistically significant difference inα-diversity between the pre-TIPS surgery group and the post-TIPS surgery group(P>0.05).However,a statistically significant difference inβ-diversity was observed when comparing the three groups(P<0.05).The preliminary study revealed that after TIPS,the abundance of Enterobacteriaceae decreased,and the B/E ratio correspondingly increased.This reversed the downward trend of the B/E ratio caused by liver cirrhosis and thus enhanced the colonization resistance of gut bacteria.In terms of carbohydrate metabolism,the gut microbiota tended to shift from the genus Bacteroides,which was more effective in decomposing carbohydrates,to the genus Prevotella,which utilized plant-based carbohydrates.In terms of lipid metabolism,the abundance of butyrate-producing Ruminococcus in the intestine decreased.Conclusion There are significant differences in the structural and functional annotations of the intestinal microbiota in patients after TIPS,which may provide a potential novel microecological strategy for the prevention and treatment of postoperative co

关 键 词：肝硬化 经颈静脉肝内门体分流术 肠道菌群 宏基因组学 

分 类 号：R575.2[医药卫生—消化系统]