Effect Of Intestinal Dysbacteriosis On Plasma Procalcitonin In Patients With Acute-on-chronic Hepatitis B Liver Failure

Background:In clinical practice,the plasma procalcitonin(PCT)level of most hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)patients without infection is obviously increased,Therefore,it is of great significance to judge the prognosis and to guide the rational use of antibacterial drugs according to the level of plasma PCT in the patients with HBV-ACLF.The purpose of this study was to explore the clinical value of elevated plasma PCT level in patients with HBV-ACLF,and to provide experimental evidence for more effective treatment.Objective:To identify the intestinal microbes in patients with HBV-ACLF by 16 s r DNA amplifier sequencing,and to analyze the correlation between the degree of intestinal dysbacteriosis(B / E value)and endotoxin(LPS),PCT,and the correlation between PCT and LPS,to investigate the effect of intestinal dysbacteriosis on plasma PCT in patients with HBV-ACLF.Methods:From October 2017 to August 2018,29 patients with HBV-ACLF and 14 patients with chronic hepatitis B(CHB)were included in the study group.On admission,venous blood was drawn from all patients and placed in a heat-free test tube before antibiotics and Intestinal microflora drugs were used.to detect LPS and PCT immediately.Fresh tail samples of patients were frozen at-80 ? and sent to A Company for DNA extraction.and the V3 and V4 supervariable regions of 16 Sr RNA gene were amplified and analyzed by high throughput sequencing technique.Taking the new index of intestinal colonization resistance(B/E value)as the index of intestinal dysbacteriosis,B / E is the ratio of Bifidobacterium to Escherichia-Statistical analysis of intestinal flora,B/E value,PCT,LPS,intestinal flora structure between two groups,and the correlation among PCT,LPS,intestinal dysbacteriosis degree and liver failure group.Results::Compared with the hepatitis B group,the beneficial bacteria such as firmicutes,actinobacteria,bifidobacterium,lactobacillus in liver failure group decreased significantly,while bacteroidetes,proteobacteria,bacteroidaceae,enterobacter and Escherichia-Shigella overgrown.The differences between the two groups were statistically significant(P<0.01,P<0.01,P=0.01,P<0.01,P<0.01,P=0.012,P<0.01,P<0.05,P=0.037);PCT(0.50(0.96))ng/m L,LPS(0.46±0.10)EU/m L,B/E value(0.04±0.01)in liver failure group and PCT(0.08 ±0.02)ng/m L,LPS(0.05±0.02)EU/m L,B/E value(1.62±0.31)in hepatitis B group,the differences between the two groups were statistically significant(P<0.01,P<0.01,P<0.01).There was a negative correlation between S value and LPS in liver failure group(r=0.81,P<0.01),a negative correlation between B/E ? and PCT(r= 0.79,P<0.01),and a positive correlation between PCT and LPS(r=0.76,P<0.01).Conclusion:The intestinal dysbacteriosis exists in patients with HBV-ACLF.The increase of PCT is correlated with the intestinal dysbacteriosis.The increase of LPS production caused by intestinal dysbacteriosis may be one of the reasons for the increase of PCT.