肠道菌群与慢性乙型肝炎发生发展及预后的关系
DOI: 10.3969/j.issn.1001-5256.2022.05.034
利益冲突声明:所有作者均声明不存在利益冲突。
作者贡献声明:郭紫薇、张嘉鑫、李硕负责设计研究,资料分析,撰写论文; 郭紫薇、朱顺、李晓斌、靳茜参与检索文献,数据提取,修改论文; 李小科、叶永安负责拟定写作思路,指导撰写文章并最后定稿。
Research advances in intestinal flora and the development and prognosis of chronic hepatitis B
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摘要: 肠道菌群与慢性乙型肝炎(CHB)存在密切关系。近年研究表明,肠道菌群的失调与CHB病情的发生、发展及预后有关,且随着疾病的进展,肠道菌群环境也可能发生变化,二者相互影响,相互作用。本文综述了肠道菌群影响CHB及其相关肝病的病情发展和菌群的调节在CHB及其相关肝病诊治中的作用,以期为CHB的临床治疗提供新思路。Abstract: Intestinal flora is closely associated with chronic hepatitis B (CHB). Recent studies have shown that the imbalance of intestinal flora is associated with the development, progression, and prognosis of CHB, and the environment of intestinal flora may also change with disease progression, suggesting that intestinal flora and CHB interact with each other. This article reviews the influence of intestinal flora on the progression of CHB and related liver diseases and the role of intestinal flora regulation in the diagnosis and treatment of CHB and related liver diseases, in order to provide new ideas for the clinical treatment of CHB.
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[1] LOK AS, MCMAHON BJ, BROWN RS JR, et al. Antiviral therapy for chronic hepatitis B viral infection in adults: A systematic review and meta-analysis[J]. Hepatology, 2016, 63(1): 284-306. DOI: 10.1002/hep.28280. [2] LU H, WU Z, XU W, et al. Intestinal microbiota was assessed in cirrhotic patients with hepatitis B virus infection. Intestinal microbiota of HBV cirrhotic patients[J]. Microb Ecol, 2011, 61(3): 693-703. DOI: 10.1007/s00248-010-9801-8. [3] MOGHADAMI M, DADASHPOUR N, MOKHTARI AM, et al. The effectiveness of the national hepatitis B vaccination program 25 years after its introduction in Iran: A historical cohort study[J]. Braz J Infect Dis, 2019, 23(6): 419-426. DOI: 10.1016/j.bjid.2019.10.001. [4] TAN M, BHADORIA AS, CUI F, et al. Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: A systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2021, 6(2): 106-119. DOI: 10.1016/S2468-1253(20)30307-1. [5] MILOSEVIC I, VUJOVIC A, BARAC A, et al. Gut-liver axis, gut microbiota, and its modulation in the management of liver diseases: A review of the literature[J]. Int J Mol Sci, 2019, 20(2): 395. DOI: 10.3390/ijms20020395. [6] COMPARE D, COCCOLI P, ROCCO A, et al. Gut-liver axis: The impact of gut microbiota on non alcoholic fatty liver disease[J]. Nutr Metab Cardiovasc Dis, 2012, 22(6): 471-476. DOI: 10.1016/j.numecd.2012.02.007. [7] SCHOELER M, CAESAR R. Dietary lipids, gut microbiota and lipid metabolism[J]. Rev Endocr Metab Disord, 2019, 20(4): 461-472. DOI: 10.1007/s11154-019-09512-0. [8] ILLIANO P, BRAMBILLA R, PAROLINI C. The mutual interplay of gut microbiota, diet and human disease[J]. FEBS J, 2020, 287(5): 833-855. DOI: 10.1111/febs.15217. [9] KANG Y, CAI Y. Gut microbiota and hepatitis-B-virus-induced chronic liver disease: Implications for faecal microbiota transplantation therapy[J]. J Hosp Infect, 2017, 96(4): 342-348. DOI: 10.1016/j.jhin.2017.04.007. [10] WEI M, CAO LT, HE YJ, et al. Intestinal microecological disorder in the development of HBV-related liver diseases[J]. Chin J Gastroenterol Hepatol, 2021, 30(1): 30-33. DOI: 10.3969/j.issn.1006-5709.2021.01.007.魏敏, 曹莉婷, 何昱静, 等. 肠道微生态紊乱在HBV感染相关肝病发生发展中的研究[J]. 胃肠病学和肝病学杂志, 2021, 30(1): 30-33. DOI: 10.3969/j.issn.1006-5709.2021.01.007. [11] NIU BY, WEI W, YAO SK. The role of Toll-like receptors in the pathogenesis of irritable bowel syndrome[J]. J China-Japan Friendship Hosp, 2021, 35(2): 116-118. DOI: 10.3969/j.issn.1001-0025.2021.02.016.牛冰玉, 魏薇, 姚树坤. Toll样受体在肠易激综合征发病机制中的作用[J]. 中日友好医院学报, 2021, 35(2): 116-118. DOI: 10.3969/j.issn.1001-0025.2021.02.016. [12] YIU JH, DORWEILER B, WOO CW. Interaction between gut microbiota and toll-like receptor: From immunity to metabolism[J]. J Mol Med (Berl), 2017, 95(1): 13-20. DOI: 10.1007/s00109-016-1474-4. [13] HU JY, SHEN H, ZHU L, et al. Research progress of bile acids in inflammatory bowel disease[J]. J Southeast Univ(Medical Science Edition), 2021, 40(1): 108-113. DOI: 10.3969/j.issn.1671-6264.2021.01.021.胡静怡, 沈洪, 朱磊, 等. 胆汁酸在炎症性肠病中作用的研究进展[J]. 东南大学学报(医学版), 2021, 40(1): 108-113. DOI: 10.3969/j.issn.1671-6264.2021.01.021. [14] WANG X, CHEN L, WANG H, et al. Modulation of bile acid profile by gut microbiota in chronic hepatitis B[J]. J Cell Mol Med, 2020, 24(4): 2573-2581. DOI: 10.1111/jcmm.14951. [15] WANG RR, JI G. Interaction between intestinal flora and bile acid in nonalcoholic fatty liver disease[J]. Chin J Integr Tradit West Med Liver Dis, 2020, 30(4): 378-382. DOI: 10.3969/j.issn.1005-0264.2020.04.028.王睿瑞, 季光. 肠道菌群和胆汁酸相互作用与非酒精性脂肪性肝病[J]. 中西医结合肝病杂志, 2020, 30(4): 378-382. DOI: 10.3969/j.issn.1005-0264.2020.04.028. [16] SEKI E, SCHNABL B. Role of innate immunity and the microbiota in liver fibrosis: Crosstalk between the liver and gut[J]. J Physiol, 2012, 590(3): 447-458. DOI: 10.1113/jphysiol.2011.219691. [17] ZHANG XX, GUO JS. Current cognition and treatment progress of chronic hepatitis B[J]. Chin Hepatol, 2021, 26(3): 327-330. DOI: 10.3969/j.issn.1008-1704.2021.03.032.张星鑫, 郭津生. 慢性乙型肝炎的现有认识及治疗进展[J]. 肝脏, 2021, 26(3): 327-330. DOI: 10.3969/j.issn.1008-1704.2021.03.032 [18] LIU J, YANG HI, LEE MH, et al. Spontaneous seroclearance of hepatitis B seromarkers and subsequent risk of hepatocellular carcinoma[J]. Gut, 2014, 63(10): 1648-1657. DOI: 10.1136/gutjnl-2013-305785. [19] BERTOLETTI A, FERRARI C. Innate and adaptive immune responses in chronic hepatitis B virus infections: Towards restoration of immune control of viral infection[J]. Gut, 2012, 61(12): 1754-1764. DOI: 10.1136/gutjnl-2011-301073. [20] GAO H, LIU SS, ZHAO ZZ, et al. Role of intestinal flora-mediated immune response in chronic hepatitis B virus infection[J]. J Clin Hepatol, 2019, 35(11): 2565-2568. DOI: 10.3969/j.issn.1001-5256.2019.11.039.高慧, 刘守胜, 赵真真, 等. 肠道菌群介导的免疫反应在慢性HBV感染中的作用[J]. 临床肝胆病杂志, 2019, 35(11): 2565-2568. DOI: 10.3969/j.issn.1001-5256.2019.11.039. [21] ZHAO XH, CAO ZY, SHEN Y, et al. Influence of Chongcao Yigan Capsule on function of intestinal flora and chemoprevention for patients with chronic hepatitis B-induced liver fibrosis[J]. Asian Pac J Cancer Prev, 2014, 15(21): 9423-9426. DOI: 10.7314/apjcp.2014.15.21.9423. [22] CHOU HH, CHIEN WH, WU LL, et al. Age-related immune clearance of hepatitis B virus infection requires the establishment of gut microbiota[J]. Proc Natl Acad Sci U S A, 2015, 112(7): 2175-2180. DOI: 10.1073/pnas.1424775112. [23] CHEN Y, CHEN Z, GUO R, et al. Correlation between gastrointestinal fungi and varying degrees of chronic hepatitis B virus infection[J]. Diagn Microbiol Infect Dis, 2011, 70(4): 492-498. DOI: 10.1016/j.diagmicrobio.2010.04.005. [24] YU LX, SCHWABE RF. The gut microbiome and liver cancer: Mechanisms and clinical translation[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(9): 527-539. DOI: 10.1038/nrgastro.2017.72. [25] ACHARYA C, SAHINGUR SE, BAJAJ JS. Microbiota, cirrhosis, and the emerging oral-gut-liver axis[J]. JCI Insight, 2017, 2(19). DOI: 10.1172/jci.insight.94416. [26] ADOLPH TE, GRANDER C, MOSCHEN AR, et al. Liver-microbiome axis in health and disease[J]. Trends Immunol, 2018, 39(9): 712-723. DOI: 10.1016/j.it.2018.05.002. [27] SCAGLIONE S, KLIETHERMES S, CAO G, et al. The epidemiology of cirrhosis in the United States: A Population-based Study[J]. J Clin Gastroenterol, 2015, 49(8): 690-696. DOI: 10.1097/MCG.0000000000000208. [28] Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.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(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. [29] CHOPYK DM, GRAKOUI A. Contribution of the intestinal microbiome and gut barrier to hepatic disorders[J]. Gastroenterology, 2020, 159(3): 849-863. DOI: 10.1053/j.gastro.2020.04.077. [30] QIN N, YANG F, LI A, et al. Alterations of the human gut microbiome in liver cirrhosis[J]. Nature, 2014, 513(7516): 59-64. DOI: 10.1038/nature13568. [31] BAJAJ JS, BETRAPALLY NS, HYLEMON PB, et al. Salivary microbiota reflects changes in gut microbiota in cirrhosis with hepatic encephalopathy[J]. Hepatology, 2015, 62(4): 1260-1271. DOI: 10.1002/hep.27819. [32] USAMI M, MIYOSHI M, YAMASHITA H. Gut microbiota and host metabolism in liver cirrhosis[J]. World J Gastroenterol, 2015, 21(41): 11597-11608. DOI: 10.3748/wjg.v21.i41.11597. [33] HUANG XY, LI GP, KOU JG, et al. Relationship between intestinal dysbacteriosis and Child-Pugh classification in patients with cirrhosis[J]. J Clin Hepatol, 2015, 31(3): 392-395. DOI: 10.3969/j.issn.1001-5256.2015.03.019.黄晓宇, 李刚平, 寇继光, 等. 肝硬化患者肠道菌群失调与Child-Pugh分级的关系[J]. 临床肝胆病杂志, 2015, 31(3): 392-395. DOI: 10.3969/j.issn.1001-5256.2015.03.019. [34] CASTVEN D, FISCHER M, BECKER D, et al. Adverse genomic alterations and stemness features are induced by field cancerization in the microenvironment of hepatocellular carcinomas[J]. Oncotarget, 2017, 8(30): 48688-48700. DOI: 10.18632/oncotarget.16231. [35] WAN M, EL-NEZAMI H. Targeting gut microbiota in hepatocellular carcinoma: Probiotics as a novel therapy[J]. Hepatobiliary Surg Nutr, 2018, 7(1): 11-20. DOI: 10.21037/hbsn.2017.12.07. [36] DAPITO DH, MENCIN A, GWAK GY, et al. Promotion of hepatocellular carcinoma by the intestinal microbiota and TLR4[J]. Cancer Cell, 2012, 21(4): 504-516. DOI: 10.1016/j.ccr.2012.02.007. [37] YOSHIMOTO S, LOO TM, ATARASHI K, et al. Obesity-induced gut microbial metabolite promotes liver cancer through senescence secretome[J]. Nature, 2013, 499(7456): 97-101. DOI: 10.1038/nature12347. [38] GR T M, WRONKA KM, KRASNOD BSKI M, et al. Profile of gut microbiota associated with the presence of hepatocellular cancer in patients with liver cirrhosis[J]. Transplant Proc, 2016, 48(5): 1687-1691. DOI: 10.1016/j.transproceed.2016.01.077. [39] PLAZA-DIAZ J, RUIZ-OJEDA FJ, GIL-CAMPOS M, et al. Mechanisms of action of probiotics[J]. Adv Nutr, 2019, 10(suppl_1): S49-S66. DOI: 10.1093/advances/nmy063. [40] MORRISON DJ, PRESTON T. Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism[J]. Gut Microbes, 2016, 7(3): 189-200. DOI: 10.1080/19490976.2015.1134082. [41] XU M, WANG B, FU Y, et al. Changes of fecal Bifidobacterium species in adult patients with hepatitis B virus-induced chronic liver disease[J]. Microb Ecol, 2012, 63(2): 304-313. DOI: 10.1007/s00248-011-9925-5. [42] LUO WR, JIANG XM, WU BB, et al. Effect of intestinal flora intensive improvement program on hepatic fibrosis, intestinal permeability index and inflammatory cytokines in patients with hepatitis B cirrhosis[J]. Chin Hepatol, 2019, 24(2): 178-181. DOI: 10.3969/j.issn.1008-1704.2019.02.023.罗万蓉, 蒋香梅, 邬碧波, 等. 肠道菌群强化改善方案对乙肝肝硬化患者肝纤维化程度、肠道通透性指标及炎性细胞因子的影响[J]. 肝脏, 2019, 24(2): 178-181. DOI: 10.3969/j.issn.1008-1704.2019.02.023. [43] ZHU Z, HAO SY. Effect of probiotics on the intestinal flora in patients with chronic hepatitis B[J]. Chin J Gastroenterol Hepatol, 2021, 30(1): 88-94. DOI: 10.3969/j.issn.1006-5709.2021.01.019.朱泽, 郝双影. 益生菌对慢性乙型肝炎患者肠道菌群的影响[J]. 胃肠病学和肝病学杂志, 2021, 30(1): 88-94. DOI: 10.3969/j.issn.1006-5709.2021.01.019. [44] YANG L, XUE H. Study on the effect of tanreqing injection on acute stroke complicated with pulmonary infection and inflammatory index[J]. Chin J Integr Tradit West Med Liver Dis, 2020, 30(5): 396-398. DOI: 10.3969/j.issn.1005-0264.2020.05.004.杨丽, 薛红. 双歧杆菌四联活菌对乙型肝炎相关慢加急性肝衰竭患者肠道菌群、炎症免疫和肝功能的影响[J]. 中西医结合肝病杂志, 2020, 30(5): 396-398. DOI: 10.3969/j.issn.1005-0264.2020.05.004. [45] WANG XY, WANG GL, NI K. Effect of probiotic therapy on intestinal flora, liver function and liver fibrosis index in patients with chronic hepatitis B[J]. Health Research, 2020, 40(2): 227-230, 233. DOI: 10.3969/j.issn.1674-6449.2020.02.028.王杏雨, 汪根良, 倪凯. 益生菌治疗对慢性乙肝患者肠道菌群、肝功能及肝纤维化指标水平的影响[J]. 健康研究, 2020, 40(2): 227-230, 233. DOI: 10.3969/j.issn.1674-6449.2020.02.028. [46] TOJO R, SUÁREZ A, CLEMENTE MG, et al. Intestinal microbiota in health and disease: Role of bifidobacteria in gut homeostasis[J]. World J Gastroenterol, 2014, 20(41): 15163-15176. DOI: 10.3748/wjg.v20.i41.15163. [47] CAO J, WANG HH, MENG XY. Efficacy of entecavir combined with bifidobacteria triple viable in hepatitis B cirrhosis[J]. J Med Theor Pract, 2021, 34(3): 425-427. DOI: 10.19381/j.issn.1001-7585.2021.03.028.曹靓, 王浩浩, 孟祥云. 恩替卡韦联合双歧杆菌三联活菌在乙型肝炎肝硬化中的疗效观察[J]. 医学理论与实践, 2021, 34(3): 425-427. DOI: 10.19381/j.issn.1001-7585.2021.03.028. [48] LI B, DENG CL. Clinical efficacy of entecavir combined with live bifidobacterium and lactobacillus tablets in the treatment of hepatitis B patients with decompensated liver cirrhosis[J]. J Pract Hepatol, 2018, 21(5): 669-672. DOI: 10.3969/j.issn.1672-5069.2018.05.004.李波, 邓存良. 恩替卡韦联合双歧杆菌乳杆菌三联活菌片治疗失代偿期乙型肝炎肝硬化临床疗效观察[J]. 实用肝脏病杂志, 2018, 21(5): 669-672. DOI: 10.3969/j.issn.1672-5069.2018.05.004. [49] KHORUTS A, SADOWSKY MJ. Understanding the mechanisms of faecal microbiota transplantation[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(9): 508-516. DOI: 10.1038/nrgastro.2016.98. [50] ZHANG H, SUN JH. Exploration on the new idea of "regulating liver and spleen" in the treatment of alcoholic liver disease based on intestinal microecology[J]. China Med Herald, 2020, 17(9): 123-126. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202009032.htm张欢, 孙劲晖. 基于肠道微生态探索"调肝理脾"法治疗酒精性肝病的新思路[J]. 中国医药导报, 2020, 17(9): 123-126. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202009032.htm [51] WEINGARDEN AR, VAUGHN BP. Intestinal microbiota, fecal microbiota transplantation, and inflammatory bowel disease[J]. Gut Microbes, 2017, 8(3): 238-252. DOI: 10.1080/19490976.2017.1290757. [52] KANG DW, ADAMS JB, GREGORY AC, et al. Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: An open-label study[J]. Microbiome, 2017, 5(1): 10. DOI: 10.1186/s40168-016-0225-7. [53] BORODY TJ, KHORUTS A. Fecal microbiota transplantation and emerging applications[J]. Nat Rev Gastroenterol Hepatol, 2011, 9(2): 88-96. DOI: 10.1038/nrgastro.2011.244. [54] PARAMSOTHY S, NIELSEN S, KAMM MA, et al. Specific bacteria and metabolites associated with response to fecal microbiota transplantation in patients with ulcerative colitis[J]. Gastroenterology, 2019, 156(5): 1440-1454. e2. DOI: 10.1053/j.gastro.2018.12.001. [55] YANG YP, ZHUANG KM, LI JY, et al. Research advances in fecal microbiota transplantation for the treatment of HBeAg-positive chronic hepatitis B[J]. J Clin Hepatol, 2020, 36(2): 414-416. DOI: 10.3969/j.issn.1001-5256.2020.02.039.杨玉平, 庄康敏, 李金莹, 等. 粪菌移植治疗HBeAg阳性慢性乙型肝炎的研究进展[J]. 临床肝胆病杂志, 2020, 36(2): 414-416. DOI: 10.3969/j.issn.1001-5256.2020.02.039. [56] CHAUHAN A, KUMAR R, SHARMA S, et al. Fecal microbiota transplantation in hepatitis B e antigen-positive chronic hepatitis B patients: A pilot study[J]. Dig Dis Sci, 2021, 66(3): 873-880. DOI: 10.1007/s10620-020-06246-x. [57] REN YD, YE ZS, YANG LZ, et al. Fecal microbiota transplantation induces hepatitis B virus e-antigen (HBeAg) clearance in patients with positive HBeAg after long-term antiviral therapy[J]. Hepatology, 2017, 65(5): 1765-1768. DOI: 10.1002/hep.29008. [58] JEGASKANDA S, AHN SH, SKINNER N, et al. Downregulation of interleukin-18-mediated cell signaling and interferon gamma expression by the hepatitis B virus e antigen[J]. J Virol, 2014, 88(18): 10412-10420. DOI: 10.1128/JVI.00111-14. [59] CHOI HH, CHO YS. Fecal microbiota transplantation: Current applications, effectiveness, and future perspectives[J]. Clin Endosc, 2016, 49(3): 257-265. DOI: 10.5946/ce.2015.117.
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