Analysis Of Correlation Between Clinical Features And Intestinal Flora In Liver Cirrhosis Patients With TIPS

Objective: To analyze the relationship between the characteristics of clinical complications and intestinal flora in patients with liver cirrhosis underwent TIPS(transjugular intrahepatic portosystemic shunt).Methods: Thirty-six patients with liver cirrhosis who met the inclusion criteria and underwent TIPS in the Department of Gastroenterology,Affiliated Hospital of Southwest Medical University from July 2018 to July 2019 were collected.Routine preoperative indicators ALB(Albumin),PLT(Platelet),PT(Prothrombin time),APTT(Activated partial thromboplastin time),CT results of the abdomen,Intraoperative detection index PVP(Portal vein pressure),and patients fecal sample were collected and admission fecal samples were extracted for 16 SrRNA high-throughput sequencing.The sequencing results were analyzed by multiple hypothesis test LEfSe method to analyze differences in bacterial flora abundance and Wilcox-Text test and t text to compare differences in bacterial diversity among groups.The correlation analysis between microorganisms and ALB,PLT,PT,APTT,and PVP indicators was performed by using the pheatmap method of R language and the lm function to estimate regression parameters and fitting regression models in R software.Results: The proportion of intestinal flora in the thrombosis group a nd non-thrombosis group is different between TIPS patients with cirrhosis,and the intestinal flora abundance is different between the two groups(P<0.05).There were more intestinal bacterial species in the thrombotic gro up.but there was no significant difference in Alpha diversity of the intes tinal flora between the thrombus group and the non-thrombotic group(P>0.05).There was a correlation between the bacteria with high abundance of intestinal flora in patients with liver cirrhosis and thrombosis indicator s(P<0.05),and it was a linear correlation between the groups.Portal hyp ertension and intestinal flora are also related.They are positively related to Leptotrichiaceae_Leptotrichia(X=11442.5,P=0.007),negatively with Lach nospiraceae_Clostridium(X=-136.8,P=0.005),Porphyromonadaceae_Parabacter oides(X=-87.6,P=0.01),Coriobacteriaceae_Eggerthella(X=-6873.1,P=0.02),Ru minococcaceae_Anaerotruncus(X=-1502.9,P=0.04).Alpha diversity statistica l differences in intestinal flora of patients with cirrhosis TIPS under diffe rent portal pressure conditions are not significant(P>0.05).Plasma albumi n and intestinal flora are also related in patients with liver cirrhosis.The level of hypoalbuminemia in liver cirrhosis patients with TIPS was posit ively correlated with Fusobacteriaceae_Fusobacterium(X=110.3,P=0.02)and Neisseriaceae_Neisseria(X=5573.8,P=0.03),but negatively with Rikenellace ae_Alistipes(X=-245.4,P=0.02).Conclusion: The composition of intestinal flora between thrombus gr oup and non-thrombosis group in liver cirrhosis patients with TIPS chang es.the proportion of the two groups is different and there is a difference in the abundance of bacteria between the thrombus group and the non-thrombotic group.The intestinal flora in the thrombus group mainly incre ased in Proteobacteria and Firmicutes.The more abundant bacteria genus and species may be related to cirrhotic portal vein thrombosis.However,there was no significant difference in the diversity of the flora in two gr oups.In addition,there was a linear correlation between the intestinal flo ra abundance in the cirrhosis patients with TIPS and various indicators o f thrombosis.Cirrhosis complication portal hypertension is related to the intestinal flora.Portal hypertension is positively related to Leptotrichiacea e_Leptotrichia,negatively related to Lachnospiraceae_Clostridiu,Porphyrom onadaceae_Parabacteroides,Coriobacteriaceae_Eggerthella,Ruminococcaceae_Anaerotruncus.The intestinal flora richness and diversity did not change significantly under different portal pressures.Similarly,cirrhosis hypoalbum inemia is also related to the intestinal flora.The albumin level is positiv ely related to Fusobacteriaceae_Fusobacteriu and Neisseriaceae_Neisseriaan d,negatively Rikenellaceae_Alistipes.The intestinal flora may participate in the formation of persistent hypoalbuminemia in cirrhosis and affect th e progression of liver disease.