肝硬化腹水患者肠道菌群变化对自发性腹膜炎的预测效能分析

Predictive effect of gut microbiota changes in cirrhotic ascites on spontaneous bacterial peritonitis

目的:观察肝硬化腹水患者肠道菌群变化预测自发性腹膜炎(SBP)的效能。方法:选取郑州大学第一附属医院2022年1月—2022年12月收治的肝硬化腹水患者112例,根据是否并发SBP将患者分为SBP组(n=42)和非SBP组(n=70),收集2组患者的一般资料和临床资料,单因素和多因素分析肝硬化腹水患者并发SBP的危险因素,Spearman相关性系数分析肠道菌群参数与SBP组患者SBP疾病严重程度的相关性,绘制受试者工作特征曲线(ROC)分析各肠道菌群参数对肝硬化腹水患者并发SBP的预测效能。结果:单因素分析显示,SBP组吸烟饮酒、IL-6≥7 pg/mL、PCT≥5 mg/L、SAA≥35 mg/L、Chao指数≤339.0、Shannon指数≤3.0、OTUs≤271.0、拟杆菌科浓度≤1%、普雷沃氏菌科浓度≤1%、毛螺菌科浓度≤1%、盐单胞菌科浓度≥10%、肠杆菌科浓度≥10%比例高于非SBP组,长期抗病毒治疗比例低于非SBP组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,IL-6≥7 pg/mL、PCT≥5 mg/L、SAA≥35 mg/L、Chao指数≤339.0、Shannon指数≤3.0、OTUs≤271.0、拟杆菌科浓度≤1%、普雷沃氏菌科浓度≤1%、毛螺菌科浓度≤1%、盐单胞菌科浓度≥10%、肠杆菌科浓度≥10%为肝硬化腹水患者并发SBP的独立危险因素,长期接受抗病毒治疗为肝硬化腹水患者并发SBP的保护因素。Spearman相关分析显示,Chao指数、Shannon指数、OTUs、拟杆菌科浓度、普雷沃氏菌科浓度、毛螺菌科浓度与SBP疾病严重程度呈正相关,盐单胞菌科浓度、肠杆菌科浓度与SBP疾病严重程度呈负相关。ROC曲线分析显示,Chao指数、Shannon指数、OTUs、拟杆菌科浓度、普雷沃氏菌科浓度、毛螺菌科浓度、盐单胞菌科浓度、肠杆菌科浓度预测肝硬化腹水患者并发SBP的AUC均>0.85。结论:炎症反应、肠道菌群紊乱为肝硬化腹水患者并发SBP的独立影响因素,其SBP疾病严重程度与Chao指数、Shannon指数、OTUs、拟杆菌科浓度、普雷沃氏菌科浓度正相关,与盐单胞菌科浓度、肠杆菌科浓度负相关,肠道菌群参数有望成为肝硬化腹水并发SBP的预测指标。

Objective:To observe the predictive effect of gut microbiota changes on spontaneous bacterial peritonitis(SBP)in patients with cirrhosis ascites.Methods:112 patients with cirrhosis ascites from January 2022 to December 2022 were included in this study.The enrolled patients were divided into a SBP group(42 cases)and a non-SBP group(70 cases)based on whether they were complicated with SBP.General and clinical data of the two groups of patients were collected and compared,and risk factors leading to cirrhosis ascites complicated with SBP were summarized through statistical univariate and multivariate logistic regression analysis.Spearman correlation coefficient was used to test the correlation between gut microbiota parameters and cirrhosis ascites complicated with SBP.ROC was plotted and AUC was observed to analyze the predictive efficacy of gut microbiota parameters on cirrhosis ascites complicated with SBP.Results:Statistical univariate analysis showed that there were some differences in smoking and drinking history,antiviral treatment and other general information,inflammatory factors,and gut microbiota related parameters in the infected group(P<0.05);Logistic multi factor regression analysis showed that IL-6≥7 pg/mL,PCT≥5 mg/L,SAA≥35 mg/L,intestinal colony Chao index≤339.0,gut microbiota Shannon index≤3.0,gut microbiota OTUs≤271.0,Bacteroidaceae≤1%,Prevotellaceae≤1%,Lachnospiraceae≤1%,Halomonadaceae≥10%,Enterobacteriaceae≥10%were risk factors for cirrhosis ascites complicated with SBP.Spearman correlation coefficient test indicated that Chao index,Shannon index,OTUs,Bacteroidaceae concentration,Prevotellaceae concentration,Lachnospiraceae concentration and SBP severity were correlated,while Halomonadaceae concentration,Enterobacteriaceae concentration and SBP severity were negatively correlated.ROC curve analysis demonstrated that the concentration of Chao index,Shannon index,OTUs,Bacteroidaceae family,Prevotellaceae family and Lachnospiraceae concentration decreased,and the concentration of Halomonadaceae family and Enterobacteriaceae family increased,all of which can cause cirrhosis ascites complicated with SBP(AUC>0.85).Conclusion:Inflammatory reaction and gut microbiota disorder are risk factors leading to SBP in cirrhotic ascites.Their incidence risk is positively correlated with Chao index,Shannon index,OTUs,Bacteroidaceae concentration,Prevotellaceae concentration,and negatively correlated with Halomonadaceae concentration and Enterobacteriaceae concentration.Gut microbiota related parameters are expected to be predictive indicators of SBP in cirrhotic ascites.