Impact of transjugular intrahepatic portosystemic shunt on gut microbiota and liver function in patients with cirrhotic portal hypertension

doi:10.3877/cma.j.issn.2095-1221.2024.05.004

Abstract

Abstract:

Objective

To evaluate the effects of transjugular intrahepatic portosystemic shunt （TIPS） on gut microbiota， mucosal barrier， and liver function in patients with cirrhotic portal hypertension and esophagogastric variceal bleeding （EGVB）.

Methods

A prospective cohort study was conducted on patients with cirrhotic portal hypertension and EGVB scheduled for TIPS.Age-and sex-matched healthy volunteers were set as the control group. Blood and stool samples were collected pre-procedure， and at 1 and 12 weeks post-TIPS. The control group provided samples once. Gut microbiota was analyzed using 16SrRNA sequencing. Plasma lipopolysaccharide （LPS），diamine oxidase （DAO）， and D-lactate （DLAC） levels were assessed via ELISA. Liver function was evaluated using an automated biochemical analyzer. Dynamic changes and differences in these indicators pre- and post-treatment were compared between groups.

Results

Portal vein pressure was significantly decreased post-TIPS compared to pre-TIPS （P＜ 0.001）. Patients with cirrhotic portal hypertension showed significantly lower gut microbiota richness and diversity than the healthy controls， with a reduction in beneficial bacteria and an increase in potential pathogens. However，at 12 weeks post-TIPS， gut microbiota richness and diversity were significantly improved， with an increase in beneficial bacteria and a marked reduction in potential pathogens. The plasma DLAC level was significantly elevated in patients with cirrhotic portal hypertension， with statistically significant differences compared to the control group at all time points. Compared to the patient group at 12 weeks post-TIPS， DAO levels were elevated both pre-TIPS and at 1 week post-TIPS. Compared to pre-TIPS levels， LPS levels were higher at 1 week post-TIPS ［（0.69 ± 0.14） vs （0.60 ± 0.21） pg/ mL］，while LPS levels decreased at 12 weeks post-TIPS［（0.55 ± 0.12） vs （0.60 ± 0.21） pg/ mL］， with statistically significant differences （all P＜ 0.05 ）.

Conclusion

Patients with cirrhotic portal hypertension exhibit dysbiosis and impaired intestinal mucosal barriers. TIPS reduces portal vein pressure and can improve gut microbiota in the long term.

Key words: Cirrhotic portal hypertension, Transjugular intrahepatic portosystemic shunt, ut microbiota, Hepatic, Stem cell

Yidan Cai, Fang Jian, Zhiqiang Zhang, Li Chen, Shian Zhang, Lei Xia, Mei Ruan, Dongliang Li. Impact of transjugular intrahepatic portosystemic shunt on gut microbiota and liver function in patients with cirrhotic portal hypertension[J]. Chinese Journal of Cell and Stem Cell(Electronic Edition), 2024, 14(05): 285-293.

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Figures/Tables 12

References 25

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序号	年龄	性别	ALT（U/L）	TBIL（μmol/L）	ALB（g/L）	PT（s）	Cr（μmol/L）	INR	Child-Pugh评分	MELD评分
1	37	男	259.9	27.8	38.1	18.0	70.0	1.4	5	9.9
2	52	男	19.0	14.1	30.4	16.0	60.3	1.3	6	5.2
3	66	女	24.0	14.9	31.9	15.1	67.6	1.3	6	5.8
4	46	男	13.0	19.8	28.9	13.6	68.3	1.1	6	5.9
5	39	男	41.0	8.1	43.7	13.5	75.8	1.1	6	3.4
6	73	女	26.0	18.3	33.6	13.6	50.1	1.1	6	2.6
7	63	男	24.0	17.3	25.9	13.3	96.0	1.1	7	8.43
8	68	男	26.0	22.7	23.4	18.3	96.4	1.5	7	13.0
9	51	男	11.0	26.8	23.5	17.5	60.9	1.5	7	8.7
10	49	男	28.7	8.1	33.9	12.1	74.0	1.1	7	2.6
11	49	男	73.1	10.5	30.5	15.0	89.0	1.4	7	8.0
12	50	男	39.0	40.3	29.5	19.3	50.7	1.6	7	9.5
13	30	女	14.5	9.2	42.7	13.8	63.0	1.2	7	3.1
14	42	男	18.0	37.9	34.6	13.5	88.2	1.1	8	10.7
15	59	男	30.0	58.6	31.4	18.3	54.5	1.5	9	11.1

序号	年龄	性别	ALT（U/L）	TBIL（μmol/L）	ALB（g/L）	PT（s）	Cr（μmol/L）	INR	Child-Pugh评分	MELD评分
1	37	男	259.9	27.8	38.1	18.0	70.0	1.4	5	9.9
2	52	男	19.0	14.1	30.4	16.0	60.3	1.3	6	5.2
3	66	女	24.0	14.9	31.9	15.1	67.6	1.3	6	5.8
4	46	男	13.0	19.8	28.9	13.6	68.3	1.1	6	5.9
5	39	男	41.0	8.1	43.7	13.5	75.8	1.1	6	3.4
6	73	女	26.0	18.3	33.6	13.6	50.1	1.1	6	2.6
7	63	男	24.0	17.3	25.9	13.3	96.0	1.1	7	8.43
8	68	男	26.0	22.7	23.4	18.3	96.4	1.5	7	13.0
9	51	男	11.0	26.8	23.5	17.5	60.9	1.5	7	8.7
10	49	男	28.7	8.1	33.9	12.1	74.0	1.1	7	2.6
11	49	男	73.1	10.5	30.5	15.0	89.0	1.4	7	8.0
12	50	男	39.0	40.3	29.5	19.3	50.7	1.6	7	9.5
13	30	女	14.5	9.2	42.7	13.8	63.0	1.2	7	3.1
14	42	男	18.0	37.9	34.6	13.5	88.2	1.1	8	10.7
15	59	男	30.0	58.6	31.4	18.3	54.5	1.5	9	11.1

		病例组	对照组	t值	P值
例数		15	15
性别（男/女）		12/3	11/4	-	0.666
年龄（岁）		51.6±12.2	55.5±9.7	1.406	0.337
肝病种类	乙型病毒性肝炎	12
	酒精性肝炎	2
	自身免疫性肝病	1
Child-Pugh评分		6.7±1.0
MELD评分		7.2±3.4

		病例组	对照组	t值	P值
例数		15	15
性别（男/女）		12/3	11/4	-	0.666
年龄（岁）		51.6±12.2	55.5±9.7	1.406	0.337
肝病种类	乙型病毒性肝炎	12
	酒精性肝炎	2
	自身免疫性肝病	1
Child-Pugh评分		6.7±1.0
MELD评分		7.2±3.4

	指标	术前	术后1周	术后12周	F值	P值
病例组	DAO（ng/mL）	1.137±0.839	1.244±0.875	0.617±0.164	5.170	0.012
	DLAC（mmol/L）	0.494±0.160	0.591±0.274	0.552±0.118	0.883	0.425
	LPS（pg/mL）	0.604±0.205	0.687±0.139	0.551±0.115	3.846	0.033
	DAO（ng/mL）	0.940±0.533
对照组	DLAC（mmol/L）	0.387±0.100
	LPS（pg/mL）	0.571±0.074
t值^a		0.695	0.995	-2.195
P值^a		0.498	0.337	0.046
t值^b		2.484	2.703	4.050
P值^b		0.026	0.017	0.001
t值^c		0.572	2.743	-0.584
P值^c		0.577	0.016	0.569

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