Restoration of the gut microbiota is associated with a decreased risk of hepatic encephalopathy after TIPS

作者：Menghao Li, Kai Li, Shihao Tang, Yong Lv, Qiuhe Wang, Zheng‐Yu Wang, Bohan Luo, Jing Niu, Ying Zhu, Wengang Guo, Wei Bai, Enxin Wang, Dongdong Xia, Zhexuan Wang, Xiaomei Li, Jie Yuan, Zhanxin Yin, Jonel Trebicka, Guohong Han · 发表于：JHEP Reports · 年份：2022 · DOI：10.1016/j.jhepr.2022.100448 · 被引用次数：47 · 研究领域：Liver Disease and Transplantation、Gut microbiota and health、Liver Disease Diagnosis and Treatment

Background & Aims Hepatic encephalopathy (HE) is a major complication after transjugular intrahepatic portosystemic shunt (TIPS) and is primarily influenced by the gut microbiota. We aimed to evaluate alterations in the microbiota after TIPS and the association between such alterations and HE. Methods We conducted a prospective longitudinal study of 106 patients with cirrhosis receiving TIPS. Faecal samples were collected before and after TIPS, and the gut microbiota was analysed by 16S ribosomal RNA sequencing. Results Among all patients, 33 developed HE (HE+ group) within 6 months after TIPS and 73 did not (HE- group), and 18 died during follow-up. After TIPS, the autochthonous taxa increased, whereas the potential pathogenic taxa decreased in the HE- group, and the autochthonous taxon Lachnospiraceae decreased in the HE+ group. Furthermore, synergism among harmful bacteria was observed in all patients, which was weakened in the HE- group ( p <0.001) but enhanced in the HE+ group ( p <0.01) after TIPS. Variations of 5 autochthonous taxa, namely, Coprococcus, Ruminococcus, Blautia, Ruminococcaceae_uncultured , and Roseburia , were negatively correlated with the severity of HE. Notably, increased abundances of Coprococcus and Ruminococcus were protective factors against HE, and the incidences of HE in patients with improved, stable, and deteriorated microbiota after TIPS were 13.3, 25.9, and 68.2%, respectively. Higher total bilirubin level, Child–Pugh score, model for end-st...