乙型肝炎肝硬化患者肠道菌群改变与HBV-DNA水平的关系

探讨乙型肝炎肝硬化患者肠道菌群变化与乙型肝炎病毒DNA（HBV-DNA）水平的关系，为该类患者的治疗提供参考。

选取2020年2月至2021年8月我院收治的65例乙型肝炎肝硬化患者为肝硬化组，57例慢性乙型肝炎患者为乙型肝炎组，另选取同期体检的55例健康志愿者对照组。采用Illumina MiSeq测序比较3组对象肠道菌群变化、肠道菌群丰度和多样性。采用荧光定量PCR检测肝硬化组、乙型肝炎组患者HBV-DNA水平。采用Pearson分析法分析肝硬化患者肠道菌群数量和HBV-DNA水平的相关性。

和对照组相比，肝硬化组、乙型肝炎组患者肠道双歧杆菌属、乳杆菌属、拟杆菌属和瘤胃球菌属数量下降（均P＜0.05），而肠杆菌属、肠球菌属、普雷沃菌属和梭菌属数量升高（均P＜0.05）。肝硬化组患者肠道双歧杆菌属数量低于乙型肝炎组（P＜0.05），而乳杆菌属、瘤胃球菌属、拟杆菌属、肠杆菌属、肠球菌属、普雷沃菌属和梭菌属对比差异均无统计学意义（均P＞0.05）。对照组患者肠道菌群Chao、Shannon指数高于乙型肝炎组和肝硬化组（均P＜0.05），同时肝硬化组Chao、Shannon指数低于乙型肝炎组（均P＜0.05）。肝硬化组患者HBV-DNA水平高于乙型肝炎组（P＜0.05）。Chao指数、Shannon指数、双歧杆菌属数量与HBV-DNA水平呈显著负相关（均P＜0.05），乳杆菌属、拟杆菌属、瘤胃球菌属、肠杆菌属、肠球菌属、普雷沃菌属、梭菌属数量与HBV-DNA水平均无显著相关性（均P＞0.05）。

乙型肝炎患者存在不同程度的肠道菌群失调，乙型肝炎肝硬化患者肠道菌群变化更为显著，且乙型肝炎肝硬化患者Chao指数、Shannon指数、双歧杆菌属数量和HBV-DNA水平呈负相关。

Relationship between changes of intestinal flora and HBV-DNA level in patients with hepatitis B cirrhosis

Objective To explore the relationship between the changes of intestinal flora in hepatitis B liver cirrhosis patients and HBV-DNA level, and provide a reference for the treatment. Methods A total of 65 patients with hepatitis B cirrhosis admitted in our hospital from February 2020 to August 2021 were selected as the cirrhosis group, and 57 patients with chronic hepatitis B were set up as hepatitis B group, with 55 healthy volunteers who underwent physical examination in the same period as the control group. Illumina MiSeq sequencing was used to analyze and compare the changes of intestinal flora, abundance and diversity of intestinal flora in the three groups. HBV-DNA levels in patients with liver cirrhosis and hepatitis B were detected using fluorescence quantitative PCR. Pearson analysis was used to analyze the correlation between the counts of intestinal flora and HBV-DNA level in patients with hepatitis B cirrhosis. Results Compared with the control group, the counts of Bifidobacteria, Lactobacillus, Bacteroides and Rumen cocci in cirrhosis group and hepatitis B group decreased (all P＜0.05), while those of Enterobacter, Enterococcus, Prevotella and Clostridium increased (all P＜0.05). The count of Bifidobacteria in cirrhosis group was lower than that in hepatitis B group (P＜0.05), but there was no significant difference in Lactobacillus, Rumen cocci, Bacteroides, Enterobacter, Enterococcus, Prevotella and Clostridium (all P＞0.05). The Chao and Shannon indexes in the control group were higher than those in hepatitis B group and cirrhosis group (all P＜0.05), while those in cirrhosis group were lower than those in hepatitis B group (all P＜0.05), respectively. The level of HBV-DNA in cirrhosis group was higher than that in hepatitis B group (P＜0.05). Chao index, Shannon index and the count of Bifidobacterium were significantly negatively correlated with HBV-DNA level (all P＜0.05), but the counts of Lactobacillus, Bacteroides, Rumen coccus, Enterobacter, Enterococcus, Prevotella and Clostridium had no significant correlation with HBV-DNA level (all P＞0.05). Conclusion There are varying degrees of intestinal flora imbalance in patients with hepatitis B, but the changes in intestinal flora of patients with hepatitis B cirrhosis are more significant, and the Chao index, Shannon index and count of Bifidobacterium are significantly negatively correlated with HBV-DNA level in hepatitis B liver cirrhosis patients.