Increased intestinal permeability as a predictor of bacterial infections in patients with decompensated liver cirrhosis and hemorrhage

Background and Aim: There have been no trials comparing the prophylactic effect of oral quinolone and intravenous cephalosporin antibiotics and elucidating the predictive factors for the occurrence of bacterial infections in cirrhotic patients with gastrointestinal bleeding in Asian‐Pacific region. Methods: One hundred and thirteen patients with advanced liver cirrhosis and active gastrointestinal hemorrhage were enrolled in our study. The patients were randomly allocated into either the oral ciprofloxacin group (n = 50, 500 mg every 12 h) or the intravenous ceftriaxone group (n = 63, 2.0 g per day for 7 days). Results: Proven or possible infections were significantly more frequent in the patients in the oral ciprofloxacin group (34.0%) than the intravenous ceftriaxone group (14.3%, P = 0.002). The intestinal permeability index (IPI, mean [SD]) measured the day after admission was significantly higher in the patients with proven or possible infections (1.45 [0.96]) compared with the no infection group (0.46 [0.48], P < 0.01). By multivariate analysis, oral ciprofloxacin prophylaxis and higher IPI at the time of inclusion were independent and significant predictors for proven or possible infections. By receiver operating characteristic curve analysis, the best cutoff value of IPI for the prediction of the occurrence of bacterial infection was 0.62%. Conclusions: The frequency of proven or possible infections was significantly lower in the intravenous ceftriaxone group compared with the oral ciprofloxacin group. The IPI measured the day after admission is a good clinical parameter predicting the occurrence of infection in these patients.     

肝硬化患者经颈静脉肝内门体分流术前后肠道菌群特征分析

目的 对比分析肝硬化患者经颈静脉肝内门体分流术(TIPS)前后肠道菌群的特征。方法 选取2018年7月-2019年7月西南医科大学附属医院消化内科住院行TIPS的肝硬化患者18例,术前采集粪便18例,术后1个月采集粪便6例,术后3个月采集粪便9例,同时收集患者术前及术后肝功能和凝血检验结果。对粪便样本采用16S rRNA高通量测序方法,生物信息分析流程使用QIIME2推荐的DADA2方法,以生成的扩增特征序列(OTU)为单位研究肠道菌群,采用多重假设检验LEfSe、SPSS(Alpha分析)、PERMANOVA(Beta分析)、Pheatmap方法分析肠道菌群。符合正态分布的计量资料不同采集时间点的指标组间比较采用重复测量资料方差分析;不符合正态分布的计量资料各时间点的组间比较采用广义估计方程,进一步两两比较采用Bonferroni法。结果 TIPS术前与术后3个时期肝功能指标对比中,TBil和总胆汁酸组间差异均有统计学意义(F值分别为8.201、39.482,P值分别为0.001、<0.001)。术后1个月粪便样本较术前相比存在Beta多样性变化(F=2.603, P=0.02),但3个时期粪便Alpha多样性差异无统计学意义(P值均>0.05)。TIPS术前门静脉压力在属水平上与双歧杆菌属﹑柯林斯菌属﹑瘤胃球菌属具有负相关性(r值分别为-0.35、-0.38、-0.34,P值分别为0.04、0.02、0.04),与牛肝菌属具有正相关性(r=0.41,P=0.015),其他检验指标也与不同的肠道菌群存在相关性(P值均<0.05)。结论 TIPS术前临床指标与肠道菌群具有相关性,TIPS术后肠道菌群组成发生变化,在属水平上差异显著。     

Feasibility and reproducibility of liver and pancreatic stiffness in patients with alcohol-related liver disease

BackgroundTo date no studies evaluated liver stiffness and pancreatic stiffness by shear-wave elastography, in alcoholic liver disease setting.AimsTo assess feasibility and reproducibility of Shear-wave elastrography in measuring liver and pancreatic stiffness in alcoholic liver disease and investigate the correlation among liver and pancreatic stiffness and clinical data.MethodsLiver and pancreatic stiffness were measured by elastography (2 examiners) in patients with alcoholic liver disease and in healthy volunteers, for reference values. Effect of clinical data was evaluated on log-transformed pancreatic or liver stiffness, using univariate and multivariate linear regression model.Results87 patients and 46 healthy volunteers enrolled. Both the stiffness values were higher in patients than healthy volunteers (p < 0.001). For liver stiffness: no failure measurements found, the Intraclass correlation coefficient (between 2 examiners) was 0.72 and the variables significantly correlated at multivariate analysis were cirrhosis (p < 0.0001) and steatosis (p = .007). For pancreatic stiffness: 2 failures found, with ICC 0.40 and the only variable significantly correlated at multivariate analysis was liver cirrhosis (p = .005).ConclusionsShear-wave elastography feasibility was good for liver and pancreatic stiffness. Reproducibility was good for liver stiffness, whereas fair for pancreatic one. Both the stiffness correlated with alcoholic liver disease severity. Elastography could be a useful tool to detect and monitor alcohol-related liver and pancreatic damage.