Objective:The aims of this study were to investigate the characteristics of intestinal flora and to evaluate the effects of TIPS on intestinal barrier in patients with portal hypertension bleeding from esophagogastric vein rupture.Methods:A prospective cohort study was conducted in 15 patients with liver cirrhosis undergoing TIPS for esophageal gastrom varicosis rupture hemorrhage,another 15 healthy people which were individually matched were taken as the control group.Blood routine examination,liver and kidney function,blood coagulation,concentrations of Diamine oxidase(DAO),D-lactate(DLAC),endotoxin(LPS)and16Sr RNA gene sequencing of patients in the 2 groups were evaluated before,1 and 12 weeks after TIPS respectively.Results:(1)TIPS can effectively reduce portal vein pressure in cirrhotic patients with esophageal and gastric varices ruptured and bleeding.The portal vein pressure was significantly decreased from 34.59± 6.02 mm Hg to 24.42±5.88 mm Hg after TIPS.The difference was statistically significant(t=10.107,P<0.001).(2)Compared with the pre-operation,ALT was temporarily increased and Cr was decreased in the first week after TIPS.The liver and kidney functions were improved and recovered in the 12 weeks after TIPS compared with the pre-operation.(3)Effects of TIPS on intestinal mucosal permeability: Compared with the control group,DLAC increased temporarily at the first week after TIPS,and the difference was statistically significant(F=3.39,P=0.026).There was no statistical significance between TIPS group and control group at each time point in the level of LPS and DAO(P≧0.05).(4)Alpha diversity: The richness of intestinal flora in cirrhotic patients with portal hypertension and esophageal and gastric varices was significantly reduced,and the difference was statistically significant compared with the control group(chao1 P <0.001,ACE P<0.001,Shannon P<0.001,Simpson P=0.026).Compared with the control group,the richness and diversity of the microflora were significantly lower at1 week postoperatively,and the difference was statistically significant(chao1 P <0.001,ACE P<0.001,Shannon P<0.001,Simpson P=0.015).The flora richness and diversity were significantly higher in 12 weeks after TIPS than that before TIPS(chao1 P=0.025,ACE P=0.037,Shannon P<0.001,Simpson P<0.001).Microflora diversity in 12 weeks after TIPS was significantly higher than that 1 week after TIPS(Shannon P<0.001,Simpson P<0.001).The richness of intestinal flora in 12 weeks after TIPS was close to the level of the control group,with no significant difference compared with the control group(P≧0.05).(5)Beta diversity reflects the difference of microbial communities between groups.Through PCo A principal coordinate analysis,concluded that the type and richness of microbiota in before TIPS group is similar to 1 week after TIPS group,the type and richness of microbiota in control group are similar to 12 weeks after TIPS group.(6)At the phylum level,compared with the before TIPS group,the abundance of Desulfobacterota and Campilobacterota were significantly increased in 12 weeks after TIPS group.Compared with the 1 week after TIPS group,the abundance of Desulfobacterota was significantly increased in 12 weeks after TIPS group.Compared with the control group,the abundances of Bacteroidota,Desulfobacterota,Deferribacteres,Campilobacterota were significantly decreased in before TIPS group.Compared with the control group,the abundances of Fusobacteriota,Desulfobacterota,Deferribacteres and Campilobacterota were significantly increased in 1 week after TIPS group.(7)At the genus level,compared with before TIPS group,the abundance of Streptococcus was significantly decreased at 12 weeks after TIPS,and the abundance of Blautia,Lactobacillus,and Clostridium was significantly increased.Compared with the control group,the abundances of Klebsiella,Streptococcus,Enterococcus,Rothia and Hungatella were significantly increased than before TIPS group,while the abundance of Roseburia,Prevotella,Lactobacillus,Megamonas,Hydrogenophaga,Candidatus,Bacilloplasma,Blautia,Bacillus,Clostridium and Pseudomonas have decreased significantly.Conclusion:1.TIPS can effectively reduce portal venous pressure in cirrhotic patients with hepatic portal hypertension and esophageal and gastric varices rupture and hemorrhage,and there is no significant effect on liver function after stent shunt.2.Intestinal mucosal permeability may increase temporarily in patients with early postoperative TIPS.3.After esophageal and gastric vein rupture and bleeding in patients with cirrhosis portal hypertension,the species abundance and diversity of intestinal flora decreased,while beneficial bacteria decreased and harmful bacteria increased.4.TIPS can effectively reduce portal pressure,the intestinal flora of patients will gradually improve with time prolong,the abundance and diversity of species and beneficial bacteria will increase and the harmful bacteria will decrease,which is conducive to improve liver function. |