肠道菌群失衡对乙型肝炎相关慢加急性肝衰竭患者血浆降钙素原升高的影响

目的 探讨肠道菌群失衡对乙型肝炎相关慢加急性肝衰竭（hepatitis B virus-related acute-on-chronic liver failure，HBV-ACLF）患者血浆降钙素原（procalcitonin，PCT）水平升高的影响。方法 检测29例HBV-ACLF（肝衰组）、14例慢性乙型肝炎（乙肝组）患者入院时的血浆PCT、内毒素（endotoxin，LPS）水平，收集患者新鲜尾便并通过高通量测序检测肠道菌群状况，统计分析两组患者间肠道菌群、B/E值、PCT和LPS水平的差异，以及肝衰组患者PCT、LPS、B/E值三者间的相关性。结果 与乙肝组患者比较，肝衰组厚壁菌门、放线菌门、双歧杆菌属、乳杆菌属等肠道菌群显著减少，而拟杆菌门、变形菌门、埃希菌属等肠道菌群过度生长，两组患者间各菌群比较差异均具有统计学意义（t=-4.84,Z=-2.84,Z=-2.57,Z=-4.39,t=3.59，t=2.64,t=2.19,P＜0.01、＜0.01、=0.01、＜0.01、＜0.01、=0.01、=0.04）；肝衰组PCT[0.50（0.96）]ng/mL、LPS（0.46±0.10）EU/mL、B/E值（0.04±0.01），乙肝组PCT（0.08±0.02）ng/mL、LPS（0.05±0.02）EU/mL、B/E值（1.62±0.31），各指标两组间比较差异均具有统计学意义（Z=-3.17，t=5.88,t=16.18,P＜0.01、0.01、0.01）；肝衰组B/E值与LPS水平呈负相关关系（r=‒0.81，P＜0.01），B/E值与PCT水平呈负相关关系（r=‒0.79，P＜0.01），且PCT水平与LPS呈正相关关系（r=0.76，P＜0.01）。结论 HBV-ACLF患者肠道菌群失衡导致肠源性LPS生成增多，而肠源性LPS促使PCT产生增多。

Effect of intestinal flora imbalance on plasma procalcitonin levelin patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To explore the effect of intestinal flora imbalance on plasma calcitonin (PCT) level in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods The levels of serum PCT and endotoxin (LPS) were measured in 29 patients with HBV-ACLF (Liver failure group) and 14 patients with chronic hepatitis B (Hepatitis B group) at admission. Fresh fecal samples were collected and the intestinal flora was detected using high-throughput sequencing. Statistical analysis was performed on the intestinal flora, B/E value, PCT, LPS, and the differences between two groups, as well as the correlation among PCT, LPS and B/E value in liver failure group. Results Compared with the hepatitis B group, the beneficial bacteria such as Firmicutes, Actinobacteria, Bifidobacterium, Lactobacillus in liver failure group decreased significantly, while Bacteroidetes, Proteobacteria and Escherichia-Shigella overgrown. The differences between the two groups were statistically significant (P<0.01, <0.01, =0.01, <0.01, ＜0.01, =0.01, =0.04). The PCT [0.50(0.96) ng/mL], LPS (0.46±0.10 EU/mL) and B/E value (0.04±0.01) in liver failure group were significantly different from the PCT (0.08 ±0.02 ng/mL), LPS (0.05±0.02 EU/mL) and B/E value (1.62±0.31) in hepatitis B group respectively (P<0.01, 0.01, 0.01 respectively). There was a negative correlation between B/E value and LPS (r=‒0.81, P<0.01), and between B/E value and PCT (r=‒0.79, P<0.01), while a positive correlation between PCT and LPS (r=0.76, P<0.01) in liver failure group. Conclusion Intestinal flora imbalance in HBV-ACLF patients leads to increased production of enterogenous LPS, and enterogenous LPS promotes PCT production.