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Gut dysbiosis is associated with poorer long-term prognosis in cirrhosis

World Journal of Hepatology 2021年第5期13卷 557-570页

作者： Roman Maslennikov Vladimir Ivashkin Irina Efremova Aliya Alieva ekaterina kashuh ekaterina Tsvetaeva Elena Poluektova Elena Shirokova Konstantin Ivashkin Department of Internal Medicine Gastroenterology and HepatologySechenov UniversityMoscow 119435Russia The Interregional Public Organization“Scientific Community for the Promotion of the Clinical Study of the Human Microbiome” Moscow 119435Russia

BACKGROUND Gut dysbiosis is common in *** To study the influence of gut dysbiosis on prognosis in *** The case-control study included 48 in-patients with cirrhosis and 21 healthy *** microbiome was assessed using 16S ribosomal ribonucleic acid gene *** used modified dysbiosis ratio(MDR):[Bacilli(%)+Proteobacteria(%)]/[Clostridia(%)+Bacteroidetes(%)].Patients with MDR more the median made up the group with severe dysbiosis,others did the group with nonsevere *** follow-up period was 4 *** The mortality rate of patients with severe dysbiosis was significantly higher than that of patients with non-severe dysbiosis(54.2%vs 12.5%;P=0.001).The presence of severe dysbiosis was independent risk factors for death[hazard ratio=8.6×(1.9-38.0);P=0.005].The abundance of Enterobacteriaceae(P=0.002),Proteobacteria(P=0.002),and Lactobacillaceae(P=0.025)was increased and the abundance of Firmicutes(P=0.025)and Clostridia(P=0.045)was decreased in the deceased patients compared with the *** deceased patients had a higher MDR value than the survivors[0.131×(0.069-0.234)vs 0.034×(0.009-0.096);P=0.004].If we applied an MDR value of 0.14 as the cutoff point,then it predicted patient death within the next year with a sensitivity of 71.4%and a specificity of 82.9%[area under the curve=0.767×(0.559-0.974)].MDR was higher in patients with cirrhosis than in health controls[0.064×(0.017-0.131)vs 0.005×(0.002-0.007);P<0.001],and in patients with decompensated cirrhosis than in patients with compensated cirrhosis[0.106×(0.023-0.211)vs 0.033×(0.012-0.074);P=0.031].MDR correlated negatively with prothrombin(r=-0.295;P=0.042),cholinesterase(r=-0.466;P=0.014)and serum albumin(r=-0.449;P=0.001)level and positively with Child–Turcotte–Pugh scale value(r=0.360;P=0.012).CONCLUSION Gut dysbiosis is associated with a poorer long-term prognosis in cirrhosis.

关键词： Cirrhosis Dysbiosis Gut ROC-analysis Microbiota Microbiome Gut-liver axis

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