Optimization Of Fecal Microbiota Transplantation On The Clinical Outcome Of Patients With Hepatic Encephalopathy

ObjectiveTo preliminarily investigate the safety of fecal microbiota transplantation（FMT）in the treatment of hepatic encephalopathy（HE）,data related to liver function,cognitive function of patients and changes in intestinal flora structure were preliminarily discussed.MethodsAccording to the inclusion and exclusion criteria,21 patients with chronic hepatitis B cirrhosis or alcoholic cirrhosis complicated with HE were selected from the Affiliated Hospital of Hangzhou Normal University.According to the wishes of patients,9 patients were treated with FMT as the experimental group,and 12 patients were not treated with FMT as the control group.The experimental group was given three cycles of FMT treatment and Standards of Care（SOC）,and the control group was given SOC treatment.The data of liver function,coagulation function,serum ammonia,Child-pugh score,MELD score,liver fibrosis,four-factor index of liver fibrosis（FIB-4）,aspartate aminotransferase and platelet ratio index（APRI）were collected one week before FMT treatment and four weeks after the last FMT treatment through the medical record system.Digital Symbol Test（DST）,Digital Connection Test A（NCT-A）and Stroop-test cognitive function assessment values;adverse reactions and HE recurrence during FMT treatment were recorded;at the same time,the bacterial 16s rRNA gene sequencing method was used in the experimental group to sequence the bacterial DNA of feces samples before and after FMT treatment.Results1.There was no significant difference between the experimental group and the control group in gender,age,TBil,ALB,PA,ALT,AST,ALP,GGT,TBA,hyaluronic acid,APRI,FIB-4,Child-pugh score and MELD score.2.Compared with the control group,AST,TBA,blood ammonia,Child-pugh score,MELD score and Stroop-test time were significantly decreased after FMT treatment（P<0.05）;aLB,PA,NCT-A and DST scores were significantly increased（P<0.05）.3.There was no obvious adverse reaction of FMT in the experimental group,and no obvious hepatic encephalopathy occurred during the follow-up period.4.Compared with before FMT treatment,the number of bacteria,the abundance of Ackermannii and Rumenococcus were increased,while the number of Bacteroides and Weirongii were decreased（P<0.05）.Intestinal flora balance,diversity,Bifidobacterium and Lactobacillus were increased（P>0.05）.ConclusionThe results of this non-randomized and small-sample pilot study suggested that FMT played a certain role in improving liver function-related indicators,cognitive function and intestinal flora structure in patients with liver cirrhosis and HE,and FMT treatment for HE had good safety.It is worth further large sample,randomized,controlled study.