Effects Of Compound Amino Acid Capsules(8-11)on Liver Synthesis And Intestinal Microbiota In Patients With Decompensated Cirrhosis

Background:The main manifestations of liver synthesis dysfunction and malnutrition are decreased albumin level in the decompensated liver cirrhosis.Hypoproteinemia and malnutrition were independent predictors of disease progression.Meanwhile,intestinal flora dysbiosis plays an important role in the development of decompensated liver cirrhosis and the occurrence of complications of cirrhosis.It is significant to improve serum albumin level and nutrient level in decompensated liver cirrhosis treatment.Currently,there is no unified treatment standard.Studies at home and abroad have shown that branched-chain amino acids play a positive role in the treatment.Purpose:The purpose of this study is to observe the effects of compound amino acid capsules(8-11)on liver synthesis and nutritional status of patients with decompensated cirrhosis.Meanwhile,observe the effect of compound amino acid capsules(8-11)on intestinal flora,and analyze the correlation between the change of intestinal flora and the symptoms and test results.Methods:A total of 82 patients with decompensated cirrhosis were recruited and randomly divided into the conventional treatment group(42 cases)and the combined treatment group with compound amino acid capsules(8-11 cases)(40 cases)for an 8-week intervention.Serum samples and fecal samples were collected before and after treatment to analyze the differences of serological indexes,symptom score indexes and nutritional status score indexes,and to compare the related indexes after treatment between the two groups.The diversity and different strains of intestinal flora were analyzed by the second-generation high-throughput sequencing method,and the correlation between bacterial structure and serology,symptom score and inflammatory indicators was analyzed by Pearson correlation.Results:1.Combined therapy significantly improved serum albumin levels in patients with decompensated cirrhosis(30.91±1.064 VS 34.30±0.889,P=0.0191).Conventional treatment did not improve hypoproteinemia(33.020±0.622 VS 29.900±0.9344,P=0.0056).The effect of combined treatment on albumin level was better than that of conventional treatment group(34.30±0.889 VS 29.900±0.9344,P=0.0011).2.Combination therapy significantly improved Child-Pugh score and nutritional status score of patients with decompensated cirrhosis(P=0.034 and 0.004,respectively).Combined treatment did not significantly improve ascites score,esophagogastric varices score,or body mass index(BMI).3.Combined treatment and conventional treatment have no significant improvement effect on coagulation function,liver fibrosis index and inflammation index.4.Child-Pugh score,ascites score,RBC,PT,hyaluronic acid and IL-6 were significantly correlated with nutrient level(Pearson correlation analysis);Child-Pugh score,RBC and IL-6 level had the most significant influence on nutritional status(R2=0.222,P<0.0001),and the reliability of the model still needs to be discussed(multiple linear regression model analysis).5.Short-term combined therapy had no significant improvement on Alpha and Beta diversity of intestinal flora.6.Combination treatment can help to improve the structure of intestinal microbiota in patients with decompensated cirrhosis.The relative abundance of Bacteroides and Ruminococcus increased,while the relative abundance of Ruminococcus_gnavus_group and Streptococcus decreased.7.Relative abundance of intestinal flora was associated with decompensation-related symptoms of cirrhosis.Conclusion:In the treatment of decompensated liver cirrhosis,compound amino acid capsules(8-11)could improve albumin level,Child-Pugh score and nutritional status score,but had no significant effect on ascites grade and esophagogastric fundus varices level.Compound amino acid capsules(8-11)had no significant effect on intestinal flora diversity,but had significant effect on individual bacterial species.The dominant strains of intestinal flora were correlated with Child-Pugh score,ascites grade,esophageal fundus varicose vein level,albumin level and tumor necrosis factorα.Compound amino acid capsules have a good application prospect in decompensation of cirrhosis.