The Analyse Of Endotoxin And Cytokine In Urine And Blood Of Minimal Hepatic Encephalopathy And Gut Flora Of Minimal Hepatic Encephalopathy

Part Ⅰ:The study of gut flora related to minimal hepatic encephalopathyObjective:Explore the relationship between gut flora and minimal hepatic encephalopathy, to find the change of gut flora in minimal hepatic encephalopathy.Method:26minimal hepatic encephalopathy (MHE) patients were screened from65patients with liver cirrhosis from October2011to April2012from the first people’s hospital in Yunnan province. All patients received12years education. We used number connect trial A and digital symbol trial to screen the MHE patients.25patients with liver cirrhosis not MHE as control, and26health family members with MHE as another control. Collect patient’s fecal and blood,testing the ammonia, extraction fecal DNA using Qigen. Through PCR and454pyrosequencing can get the16SrRNA, and bioinformatic analysis and SPSS can get the sequence of16SrRNA.Results:Observed differentiation of gut microbial communities and components among three study groups was significantly dependent upon disease or health status but not genetics and diet. The abundance and species of gut flora in patients with minimal hepatic encephalopathy have reduced (P<0.05). The diversity of gut flora in health persons is higher richness than MHE (P<0.05). The diversity of gut flora in MHE is single compared with liver cirrhosis. Compared with the health family member and liver cirrhosis,the change of MHE was that the Eubacteriaceae and Sutterellaceae lost, but Prevotellaceae and Enterobacteriaceae gained.Conclusion:NCT-A and DST were the simple and convenient methods to diagnosis MHE may be convenient and simple have lower cost, the rate was46%.The inbalance of gut flora in MHE is differ from liver cirrhosis. he change of MHE was that the Eubacteriaceae and Sutterellaceae lost, but Prevotellaceae and Enterobacteriaceae gained. PartⅡ:The evaluate of endotoxin in blood and urine of minimal hepatic encephalopathyObjective:To measured the contents of IL-12、TNF-a、IL-10、IL-1β、IL-8in blood and urine of patient with minimal hepatic encephalopathy, To discussion the meaning of these facts in the pathogenesis of minimal hepatic encephalopathy。Method:35patients with hepatitis B virus liver cirrhosis and minimal hepatic encephalopathy were screened by number connect trial A and digital symbol trial from Oct.2011to Oct.2012in the first people’s hospital in Yunnan province. as the study object, all these patients have received12years education and30patients with hepatitis B virus liver cirrhosis as controls. We collect the blood and urine of all patients and use tachypleus amebocyte lysate to test the endotoxin and flow cytometry to test the infection factors.Results:There are two patients with liver cirrhosis have high blood endotoxin (6.7%),four patients have high urine endotoxin(13.3%).18patients with minimal hepatic encephalopathy have high blood endotoxin(51.4%),20patients have high urine endotoxin(57.1%).Plasma and urine endotoxin levels were significantly higher in MHE(P<0.05).Plasma ammonia levels were significantly higher in MHE(P<0.05).Patients with MHE have higher levels of IL-12、TNF-a、IL-10、 IL-1β、IL-8(P<0.05).Conclusion:Patients with MHE have higher level of ammonia and plasma and urine endotoxin increased, patients have higher level of IL-12、TNF-a、IL-10、 IL-1β、IL-8in blood and urine. Endotoxin、infection factors and ammonia play an important role in the pathogenesis of minimal hepatic encephalopathy, and the imbalance of gut flora may be the important role in pathogenesis of MHE.