慢性乙肝肝硬化患者常见肠道菌群失衡与肝功能分级的关系研究

Relationship between intestinal flora imbalance and liver function classification in patients with chronic hepatitis B cirrhosis

目的:探讨慢性乙型病毒性肝炎(CHB)肝硬化患者常见肠道菌群失调与肝功能Child-Pugh分级的关系。方法:纳入2017年1月~2020年12月我院收治的CHB肝硬化患者208例,按肝功能Child-Pugh分级,划分为A级组(n=101)、B级组(n=86)、C级组(n=21),另纳入同期健康体检者100例为对照组。取对象粪便标本,经实时荧光定量PCR检测肠杆菌属、肠球菌属、乳酸杆菌属、双歧杆菌属、拟杆菌属、梭菌属细菌数量。结果:4组杆菌属、肠球菌属、乳酸杆菌属、双歧杆菌属、拟杆菌属、梭菌属细菌数量对比,差异均有统计学意义,且杆菌属、肠球菌属数量与Child-Pugh分级呈明显正相关,乳酸杆菌属、双歧杆菌属、拟杆菌属、梭菌属数量与Child-Pugh分级呈明显负相关。肠杆菌、肠球菌、拟杆菌、梭菌属、乳酸杆菌、双歧杆菌细菌数量对诊断Child-Pugh分级B~C级均有可靠价值,ROC曲线下面积分别0.817、0.800、0.747、0.792、0.762、0.932。结论:CHB肝硬化患者普遍存在肠道菌群失调,表现为肠杆菌属、肠球菌属数量上升,乳酸杆菌属、双歧杆菌属、拟杆菌属、梭菌属数量下降,且变化程度与肝功能有密切关系。

Objective To investigate the relationship between intestinal microflora disorder and child-pugh liver function grading in patients with chronic viral hepatitis B(CHB)cirrhosis.Methods A total of 208 patients with CHB cirrhosis admitted to our hospital from January 2017 to December 2020 were enrolled and divided into grade A group(n=101),grade B group(n=86),and Grade C group(n=21)according to child-pugh grading of liver function.Another 100 healthy subjects in the same period were included as control group.Fecal samples were collected and the numbers of enterobacter,Enterococcus,Lactobacillus,bifidobacteria,Bacteroides and Clostridium were detected by real-time fluorescence quantitative PCR.Results The number of bacillus,Enterococcus,Lactobacillus,bifidobacterium,Bacteroidetes and Clostridium in the four groups showed statistically significant differences,and the number of Bacillus and Enterococcus was significantly positively correlated with child-Pugh grading.The number of Lactobacillus,bifidobacterium,Bacteroidetes and Clostridium was negatively correlated with child-Pugh grading.The number of enterobacter,Enterococcus,Bacteroides,Clostridium,Lactobacillus and bifidobacterium had reliable value for diagnosing Child-Pugh grade B to C,and the areas under ROC curve were 0.817,0.800,0.747,0.792,0.762 and 0.932,respectively.Conclusion Intestinal microflora disorder was common in CHB cirrhosis patients,which showed that the numbers of Enterobacteria and enterococcus increased,while the numbers of Lactobacillus,bifidobacteria,Bacteroidetes and Clostridium decreased,and the change degree was closely related to liver function.