| Objective:The expression profiles of gastrointestinal microecology(GM)flora after laparoscopic splenectomy combined with pericardial devascularization(LSPD)in patients with post-hepatitis cirrhosis and portal hypertension were detected by 16S rRNA high-throughput sequencing.The expression profiles of GM flora in patients with complications of diarrhea after LSPD were explored.Changes in GM microflora expression profiles were compared with those patients without diarrhea,which provided a microecological basis for diarrhea complications after LSPD,and guided potential clinical prevention and treatment strategies.Methods:According to strict inclusion and exclusion criteria,17 patients with post-hepatitis cirrhosis admitted to the hepatobiliary and pancreatic center of Northern Jiangsu People’s Hospital from December 2017 to December 2018 were selected.All patients underwent standardized and standardized LSPD operation.All patients’first natural defecation after admission,first natural defecation after operation and stool samples at the time of diarrhea were collected(according to Hart and Dobb Diarrhea Scale(≥12 scores per day).According to the sampling time,the samples were divided into preoperative samples and postoperative samples.According to Hart and Dobb scale,the samples were divided into four groups:preoperative samples of diarrhea patients,postoperative samples of diarrhea patients,preoperative samples of non-diarrhea patients and postoperative samples of non-diarrhea patients.All stool samples were sequenced by 16S high-throughput sequencing to detect the expression profile of GM bacteria.And stool routine examination were set as well.Chao index,Shannon index and LEfSe(LDA Effect Size)were analyzed and compared among groups.B/E index and Cirrhosis Dysbiosis ratio(CDR)were calculated.Results:1.Analysis at Phylum level:There was no significant difference in GM between diarrhea patients or non-diarrhea patients before and after LSPD.2.In the aspect of Alpha diversity:(1).The richness of GM flora in diarrhea patients after operation was significantly lower than that in non-diarrhea patients after operation(P<0.05),and the Shannon index about diversity had no statistical difference;(2).The richness of GM flora in diarrhea patients before operation was significantly lower than that in non-diarrhea patients before operation(P<0.05).There was no statistical difference in Shannon index of bacterial diversity.3.LEfSe analysis showed that:(1).The results of comparison between diarrhea patients after surgery and non-diarrhea patients after surgery showed that the former group was in significantly higher richness of Enterococcus and Lautropia while a significantly lower richness of Ruminococcaceae and Lachnospiraceae including Subdoligranulu、Dorea、Anaerostipes、Roseburia、Fusicatenibacter and Lachnospirap<0.05).And Romboutsia of Peptostreptococcaceae was significantly lower in richness as well(P<0.05);(2).By comparing the preoperative group of diarrhea patients with that of non-diarrhea patients,it was found that the preoperative GM flora of diarrhea patients was significantly higher in Veillonellaceae than that of non-diarrhea patients(P<0.05),while the abundance of Subdoligranulum,Anaerostipes and Romboutsia was significantly lower than that of non-diarrhea patients(P<0.05).4.B/E value and CDR results:The Bifidobacterium abundance and B/E ratio in patients with diarrhea were significantly lower than those in patients without diarrhea(P<0.05),while the Enterobacter abundance was significantly higher(P<0.05);the protozoa abundance and CDR value in patients with diarrhea were significantly lower than those in patients without diarrhea(P<0.05),and the non-protozoa abundance was significantly higher(P<0.05).Conclusions:1.The richness of GM flora in patients with diarrhea complications after LSPD were significantly lower than those without diarrhea.2.The patients with diarrhea complications had a serious imbalance of GM before operation,which was manifested by the decrease of beneficial bacteria and the increase of conditional pathogenic bacteria.3.In the prevention of diarrhea,patients with diarrhea complications had a serious imbalance of GM before operation compared with those without diarrhea.Targeted and precise treatment should be considered in the treatment strategy. |
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