Association between gut microbiota and hepatic encephalopathy in patients with liver cirrhosis
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摘要: 肝性脑病(HE)是肝硬化患者失代偿期的重要标志,也是其最常见的死亡原因之一。近年来随着肝硬化患者肠道菌群相关研究的不断进展,肠道菌群在HE发病中的作用也引起广泛关注。目前,新一代测序技术加深了研究者对肠道菌群组成和功能的认识,针对肠道菌群的HE治疗也取得了显著效果。对于肠道菌群的研究有助于进一步明确HE的发病机制,可能为HE患者提供更多的治疗方式。Abstract: Hepatic encephalopathy ( HE) is an important indicator of decompensated cirrhosis and is one of the most common causes of death. With the development of research on gut microbiota in patients with liver cirrhosis in recent years, the role of gut microbiota in the pathogenesis of HE has attracted wide attention. At present, next-generation sequencing has deepened the understanding of the composition and function of gut microbiota among researchers, and HE treatment targeting gut microbiota has achieved remarkable results. The research on gut microbiota helps to further clarify the pathogenesis of HE and may provide more treatment methods for patients with HE.
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Key words:
- liver cirrhosis /
- hepatic encephalopathy /
- gut microbiota /
- review
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[1] VILSTRUP H, AMODIO P, BAJAJ J, et al. Hepatic encephalopathy in chronic liver disease:2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver[J]. Hepatology, 2014, 60 (2) :715-735. [2] MANCINI A, CAMPAGNA F, AMODIO P, et al. Gut∶Liver∶Brain axis:The microbial challenge in the hepatic encephalopathy[J].Food Funct, 2018, 9 (3) :1373-1388. [3] ACHARYA C, BAJAJ JS. Current management of hepatic encephalopathy[J]. Am J Gastroenterol, 2018, 113 (11) :1600-1612. [4] BAJAJ JS, RIDLON JM, HYLEMON PB, et al. Linkage of gut microbiome with cognition in hepatic encephalopathy[J]. Am J Physiol Gastrointest Liver Physiol, 2012, 302 (1) :g168-g175. [5] BAJAJ JS, HYLEMON PB, RIDLON JM, et al. Colonic mucosal microbiome differs from stool microbiome in cirrhosis and hepatic encephalopathy and is linked to cognition and inflammation[J]. Am J Physiol Gastrointest Liver Physiol, 2012, 303 (6) :g675-g685. [6] 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 (10) :1601-1611. [7] BAJAJ JS, HEUMAN DM, HYLEMON PB, et al. Altered profile of human gut microbiome is associated with cirrhosis and its complications[J]. J Hepatol, 2014, 60 (5) :940-947. [8] AHLUWALIA V, BETRAPALLY NS, HYLEMON PB, et al. Impaired gut-liver-brain axis in patients with cirrhosis[J]. Sci Rep, 2016, 6:26800. [9] YILDIZ S, DOGAN I, DOGRUMAN-AL F, et al. Association of enteric protist blastocystis spp. and gut microbiota with hepatic encephalopathy[J]. J Gastrointestin Liver Dis, 2016, 25 (4) :489-497. [10] CHEN Y, YANG F, LU H, et al. Characterization of fecal microbial communities in patients with liver cirrhosis[J]. Hepatology, 2011, 54 (2) :562-572. [11] FELIPO V, URIOS A, MONTESINOS E, et al. Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy[J]. Metab Brain Dis, 2012, 27 (1) :51-58. [12] LU BJ, ZHAO YH, AN YT, et al. Research advances in gut microbiota in liver cirrhosis and related complications[J]. J Clin Hepatol, 2018, 34 (11) :2433-2437. (in Chinese) 鲁冰洁, 赵亚红, 安泳潼, 等.肠道微生物在肝硬化及相关并发症中的研究进展[J].临床肝胆病杂志, 2018, 34 (11) :2433-2437. [13] HE ZJ, SONG HY. Research progress of the relationship between intestinal flora and cirrhosis[J]. Med Recapitulate, 2017, 23 (20) :3984-3988. (in Chinese) 何志钧, 宋怀宇.肠道菌群与肝硬化关系的研究进展[J].医学综述, 2017, 23 (20) :3984-3988. [14] LYU XY, LI L. Clinical effect of rifaximin in treatment of complications associated with liver cirrhosis[J]. J Clin Hepatol, 2018, 34 (7) :1551-1554. (in Chinese) 吕新月, 李磊.利福昔明在肝硬化相关并发症中的应用[J].临床肝胆病杂志, 2018, 34 (7) :1551-1554. [15] TREBICKA J, KRAG A, GANSWEID S, et al. Endotoxin and tumor necrosis factor-receptor levels in portal and hepatic vein of patients with alcoholic liver cirrhosis receiving elective transjugular intrahepatic portosystemic shunt[J]. Eur J Gastroenterol Hepatol, 2011, 23 (12) :1218-1225. [16] MORTENSEN C, KARLSEN S, GRONBAEK H, et al. No difference in portal and hepatic venous bacterial DNA in patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt insertion[J]. Liver Int, 2013, 33 (9) :1309-1315. [17] LYNCH SV, PEDERSEN O. The human intestinal microbiome in health and disease[J]. N Engl J Med, 2016, 375 (24) :2369-2379. [18] QIN N, YANG F, LI A, et al. Alterations of the human gut microbiome in liver cirrhosis[J]. Nature, 2014, 513 (7516) :59-64. [19] YANO JM, YU K, DONALDSON GP, et al. Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis[J]. Cell, 2015, 161 (2) :264-276. [20] TILG H, CANI PD, MAYER EA. Gut microbiome and liver diseases[J]. Gut, 2016, 65 (12) :2035-2044. [21] RONNEMAA E, ZETHELIUS B, VESSBY B, et al. Serum fatty-acid composition and the risk of Alzheimer's disease:A longitudinal population-based study[J]. Eur J Clin Nutr, 2012, 66 (8) :885-890. [22] LACHAR J, BAJAJ JS. Changes in the microbiome in cirrhosis and relationship to complications:Hepatic encephalopathy, spontaneous bacterial peritonitis, and sepsis[J]. Semin Liver Dis, 2016, 36 (4) :327-330. [23] RIDLON JM, ALVES JM, HYLEMON PB, et al. Cirrhosis, bile acids and gut microbiota:Unraveling a complex relationship[J]. Gut Microbes, 2013, 4 (5) :382-387. [24] RIGGIO O, MANNAIONI G, RIDOLA L, et al. Peripheral and splanchnic indole and oxindole levels in cirrhotic patients:A study on the pathophysiology of hepatic encephalopathy[J].Am J Gastroenterol, 2010, 105 (6) :1374-1381. [25] KONOPELSKI P, UFNAL M. Indoles-gut bacteria metabolites of tryptophan with pharmacotherapeutic potential[J]. Curr Drug Metab, 2018, 19 (10) :883-890. [26] BAJAJ JS, GILLEVET PM, PATEL NR, et al. A longitudinal systems biology analysis of lactulose withdrawal in hepatic encephalopathy[J]. Metab Brain Dis, 2012, 27 (2) :205-215. [27] LIU Q, DUAN ZP, HA DK, et al. Synbiotic modulation of gut flora:Effect on minimal hepatic encephalopathy in patients with cirrhosis[J]. Hepatology, 2004, 39 (5) :1441-1449. [28] BAJAJ JS, HEUMAN DM, SANYAL AJ, et al. Modulation of the metabiome by rifaximin in patients with cirrhosis and minimal hepatic encephalopathy[J]. PLo S One, 2013, 8 (4) :e60042. [29] LUNIA MK, SHARMA BC, SHARMA P, et al. Probiotics prevent hepatic encephalopathy in patients with cirrhosis:A randomized controlled trial[J]. Clin Gastroenterol Hepatol, 2014, 12 (6) :1003-1008. [30] BAJAJ JS, HEUMAN DM, HYLEMON PB, et al. Randomised clinical trial:Lactobacillus GG modulates gut microbiome, metabolome and endotoxemia in patients with cirrhosis[J]. Aliment Pharmacol Ther, 2014, 39 (10) :1113-1125. [31] ZUO Z, FAN H, TANG XD, et al. Effect of different treatments and alcohol addiction on gut microbiota in minimal hepatic encephalopathy patients[J]. Exp Ther Med, 2017, 14 (5) :4887-4895. [32] FULLER R. Probiotics in man and animal[J]. J Appl Bacteriol, 1989, 66 (5) :36-378. [33] MCGEE RG, BAKENS A, WILEY K, et al. Probiotics for patients with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2011, 11:cd008716. [34] SHUKLA S, SHUKLA A, MEHBOOB S, et al. Meta-analysis:The effects of gut flora modulation using prebiotics, probiotics and synbiotics on minimal hepatic encephalopathy[J]. Aliment Pharmacol Ther, 2011, 33 (6) :662-671. [35] HOLTE K, KRAG A, GLUUD LL. Systematic review and meta-analysis of randomized trials on probiotics for hepatic encephalopathy[J]. Hepatol Res, 2012, 42 (10) :1008-1015. [36] XU J, MA R, CHEN LF, et al. Effects of probiotic therapy on hepatic encephalopathy in patients with liver cirrhosis:An updated meta-analysis of six randomized controlled trials[J].Hepatobiliary Pancreat Dis Int, 2014, 13 (4) :354-360. [37] ZHAO LN, YU T, LAN SY, et al. Probiotics can improve the clinical outcomes of hepatic encephalopathy:An update meta-analysis[J]. Clin Res Hepatol Gastroenterol, 2015, 39 (6) :674-682. [38] SAAB S, SURAWEERA D, AU J, et al. Probiotics are helpful in hepatic encephalopathy:A meta-analysis of randomized trials[J]. Liver Int, 2016, 36 (7) :986-993. [39] DALAL R, MCGEE RG, RIORDAN SM, et al. Probiotics for people with hepatic encephalopathy[J]. Cochrane Database Syst Rev, 2017, 2:cd008716. [40] CAO Q, YU CB, YANG SG, et al. Effect of probiotic treatment on cirrhotic patients with minimal hepatic encephalopathy:A meta-analysis[J]. Hepatobiliary Pancreat Dis Int, 2018, 17 (1) :9-16. [41] VIRAMONTES HD, AVERY A, STOW R. The Effects of probiotics and symbiotics on risk factors for hepatic encephalopathy:A systematic review[J]. J Clin Gastroenterol, 2017, 51 (4) :312-323. [42] MALAGUARNERA G, GIORDANO M, NUNNARI G, et al. Gut microbiota in alcoholic liver disease:Pathogenetic role and therapeutic perspectives[J]. World J Gastroenterol, 2014, 20 (44) :16639-16648. [43] MALAGUARNERA M, GARGANTE MP, MALAGUARNERA G, et al. Bifidobacterium combined with fructo-oligosaccharide versus lactulose in the treatment of patients with hepatic encephalopathy[J]. Eur J Gastroenterol Hepatol, 2010, 22 (2) :199-206. [44] CHEN W, YANG T, LIU WL. The clinical application of fecal microbiota transplantation[J/CD]. Chin J Transplant:Electronic Edition, 2018, 12 (1) :42-48. (in Chinese) 陈卫, 杨涛, 刘玮丽.粪菌移植的临床应用[J/CD].中华移植杂志:电子版, 2018, 12 (1) :42-48. [45] KAO D, ROACH B, PARK H, et al. Fecal microbiota transplantation in the management of hepatic encephalopathy[J].Hepatology, 2016, 63 (1) :339-340. [46] BAJAJ JS, KASSAM Z, FAGAN A, et al. Fecal microbiota transplant from a rational stool donor improves hepatic encephalopathy:A randomized clinical trial[J]. Hepatology, 2017, 66 (6) :1727-1738. [47] SARANGI AN, GOEL A, SINGH A, et al. Faecal bacterial microbiota in patients with cirrhosis and the effect of lactulose administration[J]. BMC Gastroenterol, 2017, 17 (1) :125. [48] KANG SH, LEE YB, LEE JH, et al. Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy[J]. Aliment Pharmacol Ther, 2017, 46 (9) :845-855. [49] KALAMBOKIS GN, MOUZAKI A, RODI M, et al. Rifaximin improves thrombocytopenia in patients with alcoholic cirrhosis in association with reduction of endotoxaemia[J]. Liver Int, 2012, 32 (3) :467-475. [50] BAJAJ JS. Review article:Potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and other complications of cirrhosis[J]. Aliment Pharmacol Ther, 2016, 43 (Suppl 1) :11-26. [51] BROWN EL, XUE Q, JIANG ZD, et al. Pretreatment of epithelial cells with rifaximin alters bacterial attachment and internalization profiles[J]. Antimicrob Agents Chemother, 2010, 54 (1) :388-396. [52] RAI R, AHUJA CK, AGRAWAL S, et al. Reversal of lowgrade cerebral edema after lactulose/rifaximin therapy in patients with cirrhosis and minimal hepatic encephalopathy[J].Clin Transl Gastroenterol, 2015, 6:e111. [53] TSAI CF, CHEN MH, WANG YP, et al. Proton pump inhibitors increase risk for hepatic encephalopathy in patients with cirrhosis in a population study[J]. Gastroenterology, 2017, 152 (1) :134-141. [54] ACHARYA C, BETRAPALLY NS, GILLEVET PM, et al. Chronic opioid use is associated with altered gut microbiota and predicts readmissions in patients with cirrhosis[J]. Aliment Pharmacol Ther, 2017, 45 (2) :319-331.
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