[1]张 冬,胡 萌,卓永祥,等.失代偿期肝硬化患者TIPS前后肠道菌群与血氨变化相关性的研究[J].介入放射学杂志,2025,34(06):590-596.[doi:10.3969/j.issn.1008-794X.2025.06.006]
　ZHANG Dong,HU Meng,ZHOU Yongxiang,et al.Correlation between gut microbiota and blood ammonia changes before and after TIPS in patients with decompensated cirrhosis[J].J Intervent Med,2025,34(06):590-596.[doi:10.3969/j.issn.1008-794X.2025.06.006]
点击复制

失代偿期肝硬化患者TIPS前后肠道菌群与血氨变化相关性的研究()

PDF下载中关闭

分享到：

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
34
期数:
2025年06
页码:
590-596
栏目:
血管介入
出版日期:
2025-06-25

文章信息/Info

Title:
Correlation between gut microbiota and blood ammonia changes before and after TIPS in patients with decompensated cirrhosis
文章编号:
1008-794X(2025)-006-0590-07
作者:
张 冬;  胡 萌;  卓永祥;  李 丹;  邓远军;  田广俊
519000 广东珠海 广东省中医院珠海医院肝病科
Author(s):
ZHANG Dong; HU Meng; ZHOU Yongxiang; LI Dan; DENG Yuanjun; TIAN Guangjun.
Department of Hepatology,Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine,Zhuhai,Guangdong Province 519000,China
关键词:
经颈静脉肝内门体分流术;  肠道菌群;  血氨;  相关性
分类号:
R657.3+2
DOI:
10.3969/j.issn.1008-794X.2025.06.006
文献标志码:
A
摘要:
目的 探究经颈静脉肝内门体分流术(TIPS)对肝硬化失代偿期患者肠道菌群、血氨的影响,并分析肠道菌群与血氨的相关性。方法 选取2021年7月至2023年12月因肝硬化失代偿期门静脉高压伴食管胃底静脉曲张破裂出血和(或)难治性腹水于广东省中医院珠海医院进行TIPS的患者,收集患者TIPS前后的血液和粪便样本,观察患者血常规、凝血酶原时间、肝功能和血氨变化,采用16SrRNA高通量测序检测肠道菌群变化,Spearman相关分析评估肠道菌群与血氨的相关性。结果 20例患者TIPS后1个月天冬氨酸转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、凝血酶原时间(PT)、血氨水平较术前升高(P<0.05),白蛋白(Alb)水平较术前降低(P<0.05); TIPS后3个月TBil、DBil、PT、血氨水平较术前升高(P<0.05)。TIPS后1个月患者肠道菌群beta多样性与术前比较存在明显差异(P<0.05),术后韦荣氏球菌属、链球菌属、嗜血杆菌属等有害菌显著减少,差异具有统计学意义(P<0.05)。肠道菌群与血氨的相关性分析结果表明,T0组Colidextribacter与血氨呈正相关,罗氏菌属与血氨呈负相关,T1组Colidextribacter、链球菌属与血氨呈正相关,粪球菌属、双歧杆菌属、副萨特氏菌属与血氨呈负相关,差异具有统计学意义(P<0.05)。结论 TIPS后患者肠道菌群结构发生明显改变,部分菌群与血氨水平存在相关性,调节肠道微生态或有助于降低TIPS后血氨水平。

参考文献/References:

[1] 中华医学会肝病学分会.肝硬化诊治指南[J].临床肝胆病杂志,2019,35:2408-2425.
[2]Iwakiri Y.Pathophysiology of portal hypertension[J].Clin Liver Dis,2014,18:281-291.
[3]郑鸾鸾,韩国宏,樊代明.经颈静脉肝内门体分流术在肝硬化静脉曲张出血防治中的地位[J].临床肝胆病杂志,2014,30:687-690.
[4]Berlioux P,Robicm M,Poirsonh H,et al.Pretransjugular in trahepatic portosystemic shunts(TIPS)prediction of post-TIPS overt hepatic encephalopathy:the critical flicker frequency is more accurate than psychometric tests[J].Hepatology,2014,59:622-629.
[5]Fonio P,Discalzi A,Calandri M,et al.Incidence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt(TIPS)according to its severity and temporal grading classification[J].Radiol Med,2017,122:713-721.
[6]林 镛,颜耿杰,冯 逢,等.基于16SrRNA技术探讨轻微型肝性脑病患者肠道菌群的变化特征[J].中西医结合肝病杂志,2022,32:201-206.
[7]Zhang Z,Zhai H,Geng J,et al.Large-scale survey of gut microbiota associated with MHE Via 16S rRNA-based pyrosequencing[J].Am J Gastroenterol,2013,108:1601-1611.
[8]Baffy G.Potential mechanisms linking gut microbiota and portal hypertension[J].Liver Int,2019,39:598-609.
[9]Guo L,Wang LS.The research on gut microbiota dysbiosis in liver cirrhosis patients:current status[J].Chin J Microecol,2018,30:104-108.
[10]秦子文,刘晶涛,范晓红,等.肠道菌群与肝性脑病的关系[J].胃肠病学和肝病学杂志,2021,30:34-37.
[11]Philips CA,Augustine P.Gut barrier and microbiota in cirrhosis[J].J Clin Exp Hepatol,2022,12:625-638.
[12]郭晓霞,胡 娜,廉晓晓,等.肝硬化患者肠道菌群失调的特征及驱动因子分析[J].临床肝胆病杂志,2020,36:1527-1533.
[13]张 群,王宪波.肠道菌群在门静脉高压发病机制中的作用[J].临床肝胆病杂志,2020,36:673-676.
[14]宦 徽,童 欢,魏 波,等.经颈静脉肝内门体静脉分流术联合胃左静脉栓塞术对肝硬化患者肝功能的影响[J].中华消化杂志,2017,37:404-410.
[15]Teng D,Zuo H,Liu L,et al.Long-term clinical outcomes in patients with viral hepatitis related liver cirrhosis after transjugular intrahepatic portosystemic shunt treatment[J].Virol J,2018,15:151.
[16]Karasu Z,Gurakar A,Kerwin B,et al.Effect of transjugular intrahepatic portosystemic shunt on thrombocytopenia associated with cirrhosis[J].Dig Dis Sci,2000,45:1971-1976.
[17]徐快乐,周春泽,吕维富.经颈静脉肝内门体分流术对门静脉高压患者脾脏体积及血小板数量的影响[J].医学影像学杂志,2023,33:587-590.
[18]Vozzo CF,Singh T,Bullen J,et al.Hospital readmission following transjugular intrahepatic portosystemic shunt:a 14-year single-center experience[J].Gastroenterol Rep(Oxf),2020,8:98-103.
[19]李梦羽,周希乔.肝性脑病发病机制的研究进展[J].胃肠病学,2020,25:116-120.
[20]杨 凯,张学贤,赵 卫,等.经颈静脉肝内门体分流术后肝性脑病研究进展[J].介入放射学杂志,2021,30:1180-1183.
[21]梁淑文,屈昌民,王晓英,等.肝性脑病患者肠道菌群变化的临床研究[J].医学研究杂志,2015,44:68-70.
[22]汤世豪,陈 辉,韩国宏.肠道菌群与肝硬化肝性脑病的关系[J].临床肝胆病杂志,2019,35:1109-1113.
[23]Won SM,Oh KK,Gupta H,et al.The link between gut microbiota and hepatic encephalopathy[J].Int J Mol Sci,2022,23:8999.
[24]Raygoza Garay JA,Turpin W,Lee SH,et al.Gut microbiome composition is associated with future onset of crohn's disease in healthy first-degree relatives[J].Gastroenterology,2023,165:670-681.
[25]Zhu X,Cai J,Wang Y,et al.A high-fat diet increases the characteristics of gut microbial composition and the intestinal damage associated with non-alcoholic fatty liver disease[J].Int J Mol Sci,2023,24:16733.
[26]Bajaj JS,Betrapally NS,Hylemon PB,et al.Salivary microbiota reflects changes in gut microbiota in cirrhosis with hepatic encephalopathy[J].Hepatology,2015,62:1260-1271.
[27]Tilg H,Cani PD,Mayer EA.Gut microbiome and liver diseases[J].Gut,2016,65:2035-2044.
[28]Singh V,Lee G,Son H,et al.Butyrate producers,"The Sentinel of Gut":their intestinal significance with and beyond butyrate,and prospective use as microbial therapeutics[J].Front Microbiol,2023,13:1103836.
[29]Li M,Li K,Tang S,et al.Restoration of the gut microbiota is associated with a decreased risk of hepatic encephalopathy after TIPS[J].JHEP Rep,2022,4:100448.
[30]张绍全,林炳亮.肠道菌群与肝硬化研究进展[J].实用肝脏病杂志,2023,26:313-316.
(收稿日期:2024-06-28)
(本文编辑:茹 实)

相似文献/References:

[1]张书田,崔进国.经颈静脉肝内门体分流术对肝功能影响的初步研究[J].介入放射学杂志,1998,(04):220.
[2]谢苏庆,许国铭.治疗门脉高压的新途径——经颈静脉肝内门体分流术[J].介入放射学杂志,1994,(02):116.
[3]张子曙,黄祥龙,沈天真,等.经颈静脉肝内门体分流术[J].介入放射学杂志,1994,(04):239.
[4]原姗姗,韩国宏,樊代明.ＴＩＰＳ治疗门静脉高压并发症预后评价的现状[J].介入放射学杂志,2011,(03):245.
　YUAN Shan-shan,HAN Guo-hong,FAN Dai-ming..TIPS treatment of the complications of portal hypertension: the current status of its prognostic evaluation [J].J Intervent Med,2011,(06):245.
[5]安　涛,阮　娜,罗翰林,等.MRI融合导航经颈静脉肝内门体分流术的临床优势和经验[J].介入放射学杂志,2023,32(02):119.
　AN Tao,RUAN Na,LUO Hanlin,et al.Transjugular intrahepatic portosystemic shunt with help of MRI fusion image navigation technique: its clinical advantages and preliminary experience[J].J Intervent Med,2023,32(06):119.
[6]窦树彬,陆圣月.改良经颈静脉肝内门体分流术双支架植入治疗肝硬化门静脉高压临床效果[J].介入放射学杂志,2023,32(02):127.
　DOU Shubin,LU Shengyue..Modified transjugular intrahepatic portosystemic shunt and double-stent implantation technique in the treatment of cirrhotic portal hypertension: analysis of its clinical effect [J].J Intervent Med,2023,32(06):127.
[7].门静脉高压介入性精准分流[J].介入放射学杂志,2024,33(10):1045.
　MA Jingqin,LUO Jianjun,YAN Zhiping..Interventional precision shunting for portal hypertension[J].J Intervent Med,2024,33(06):1045.
[8]李如春,胡继红,潘文秋,等.TIPS治疗肝硬化伴或不伴门静脉血栓临床对比研究[J].介入放射学杂志,2024,33(10):1101.
　LI Ruchun,HU Jihong,PAN Wenqiu,et al.TIPS for the treatment of cirrhosis with or without portal vein thrombosis：a comparative study[J].J Intervent Med,2024,33(06):1101.
[9]吴昱霖,侯昌龙,熊柏柱,等.TIPS治疗土三七致肝窦阻塞综合征中长期生存分析[J].介入放射学杂志,2025,34(02):180.
　WU Yulin,HOU Changlong,XIONG Baizhu,et al.Transjugular intrahepatic portosystemic shunt for hepatic sinusoidal obstruction syndrome caused by Gynura segetum：analysis of the mid-to-long-term survival[J].J Intervent Med,2025,34(06):180.
[10]王小泽,李 肖.从评分到人工智能——经颈静脉肝内门体分流术后肝性脑病预测的演变与挑战[J].介入放射学杂志,2025,34(05):449.[doi:10.3969/j.issn.1008-794X.2025.05.001]
　WANG Xiaoze,LI Xiao.Department of Gastroenterology,West China Hospital,et al.From scoring to artificial intelligence:the evolution and challenges in predicting hepatic encephalopathy after TIPS[J].J Intervent Med,2025,34(06):449.[doi:10.3969/j.issn.1008-794X.2025.05.001]

备注/Memo

备注/Memo:
基金项目: 广东省医学科学技术研究基金(A2021278),国家中医优势专科建设项目(国家中医药医政函[2024]90号)
通信作者: 田广俊 E-mail:guangjuntian@126.com
更新日期/Last Update: 2025-06-25