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中华消化病与影像杂志(电子版) ›› 2025, Vol. 15 ›› Issue (02) : 135 -143. doi: 10.3877/cma.j.issn.2095-2015.2025.02.008

论著

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
王玉琳1, 王中华2, 刘子文2, 吕梦鑫2, 于源滋2, 李涛2, 胡锦华2, 张小茜1,()   
  1. 1. 261000 山东潍坊,山东第二医科大学附属医院消化内科
    2. 250000 济南,山东第一医科大学附属省立医院消化内科
  • 收稿日期:2024-11-10 出版日期:2025-04-01
  • 通信作者: 张小茜
  • 基金资助:
    山东省自然科学基金(ZR2020MH053,ZR2022LSW004)

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

Yulin Wang1, Zhonghua Wang2, Ziwen Liu2, Mengxin Lyu2, Yuanzi Yu2, Tao Li2, Jinhua Hu2, Xiaoqian Zhang1,()   

  1. 1. Department of Gastroenterology,Affiliated Hospital of Shandong Second Medical University,Weifang 261000,China
    2. Department of Gastroenterology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250000,China
  • Received:2024-11-10 Published:2025-04-01
  • Corresponding author: Xiaoqian Zhang
引用本文:

王玉琳, 王中华, 刘子文, 吕梦鑫, 于源滋, 李涛, 胡锦华, 张小茜. 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[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(02): 135-143.

Yulin Wang, Zhonghua Wang, Ziwen Liu, Mengxin Lyu, Yuanzi Yu, Tao Li, Jinhua Hu, Xiaoqian Zhang. Metagenomics analysis of intestinal microbiota in patients with liver cirrhotic gastrointestinal bleeding before and after transjugular intrahepatic portosystemic shunt[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(02): 135-143.

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 in α-diversity between the pre-TIPS surgery group and the post-TIPS surgery group (P>0.05). However,a statistically significant difference in β-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 complications of TIPS.

表1 入组患者的基本特征
图1 物种稀释曲线箱线图
图2 门、纲水平物种α-多样性箱线图 注:物种α 多样性箱线图。每个箱线图代表了一个多样性指数,横坐标和不同的箱体代表分组,纵坐标为指数值,柱子上方的横线连接两个分组,横线上方为两组间的统计检验标识或P 值:****P<0.0001,***P<0.001,**P<0.01,*P<0.05,ns 表示P>0.05,NS 表示P=1。
图3 基于PLS-DA 方法的组间肠道菌群结构分析图
图4 门水平的物种丰度柱状堆叠图
表2 属水平上物种丰度分布表
图5 物种LEfSe LDA 值分布柱状图
图6 Pre-T 组和HC 组功能差异STAMP 分析
图7 Pre-T 组、Post-T 组和HC 组功能差异STAMP 分析
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