Small Intestinal Bacterial Overgrowth And Tlr4 Expression On The Surface Of Peripheral Blood Mononuclear Cells In Patients With Liver Cirrhosis

Background China is a big country with liver diseases.There are more than 100 million patients with chronic liver diseases.Among them,patients with liver cirrhosis are currently the main cause of death from liver disease.The occurrence and development of liver cirrhosis is a chronic and long-term disease course.It is related to many factors such as virus,alcohol and drugs.The specific mechanism is not yet fully understood.In recent years,studies have shown that peripheral blood mononuclear cells toll-like receptor 4(TLR4)involved in the development of cirrhosis,and its receptor regulation of a variety of factors,such as hepatitis B virus,endotoxin and so on[1,2].Patients with liver cirrhosis are prone to intestinal flora disorder,of which small intestinal bacterial overgrowth(SIBO)is the most common,and SIBO can aggravate and promote the development of cirrhosis,whether it also participates in the progression of cirrhosis by affecting the regulation of TLR4,the exact mechanism remains unclear.Therefore,the study of SIBO and its changes of peripheral blood TLR4 expression in the pathogenesis of liver cirrhosis,and its timely detection and intervention to slow the progression of cirrhosis has attracted more and more attention.Objective To explore the prevalence of SIBO and the changes of TLR4 expression on the surface of peripheral blood mononuclear cells(PBMCs)in patients with liver cirrhosis.Methods SIBO was detected by lactulose hydrogen breath test in 40 cirrhotics and 16 healthy persons.Hydrogen breath gross were also measured in all subjects who exhaled gas within 90 minutes(LHBT set-value).Determination of serum IL-6 levels by enzyme linked immunosorbent assay.Plasma endotoxin concentration was measured with limilus lysate test.TLR4 expression was assayed by flow cytometry.Results The prevalence of SIBO in patients with liver cirrhosis was 42.5%,significantly higher than 6.3% in healthy people(P<0.01);The LHBT intestinal set value,the plasma endotoxin concentration,the serum level of IL-6 and TLR4 in cirrhotic patients respectively were(117.22 ± 46.37)ppm,(0.15 ± 0.08)EU / ml,(78.66 ± 28.92)pg / ml and(24.67±9.94)GMF,significantly higher than(34.94 ± 17.08)ppm,(0.02 ± 0.01)EU / ml,(22.14 ± 5.93)pg / ml and(14.55 ± 5.25)GMF in healthy people(P<0.01);The LHBT intestinal set value,the plasma endotoxin concentration,the serum level of IL-6 and TLR4 in cirrhotic patients with SIBO-positive respectively were(176.26±58.53)ppm ?(0.27±0.10)EU/ml,(88.95±27.87)pg/ml,(29.86±11.06)GMF,significantly higher than(87.23±42.01)ppm,(0.11±0.04)EU/ml,(60.35±17.92)pg/ml,(17.78±6.95)GMF in cirrhotic patients with SIBO-negative(P<0.01);LHBT intestinal set value was positive correlated with plasma endotox level and the expression TLR4 among cirrhotic patients(P<0.01);Endotox level was positive correlated with the serum level of IL-6 and the expression TLR4 among cirrhotic patients(P<0.05).Conclusion There is a higher incidence of SIBO in patients with cirrhosis,and plasma endotoxin levels,serum IL-6 levels,and TLR4 expression on peripheral blood mononuclear cells are elevated.SIBO may induce upregulation of TLR4 through its associated intestinal endotoxemia and participate in the development of cirrhosis.