Changes in intestinal flora in patients with primary liver cancer after transcatheter arterial chemoembolization

• Main Author: LI Kezhi
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2020-05-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=10775
• ISSN: 1001-5256; 1001-5256

ObjectiveTo investigate the changes in the diversity and structure of intestinal flora in patients with primary liver cancer after transcatheter arterial chemoembolization (TACE). MethodsA total of 65 patients with primary liver cancer (among whom 20 received TACE) who were treated in The Affiliated Tumor Hospital of Guangxi Medical University from September 2018 to January 2019 were enrolled, and 27 individuals who underwent physical examination were enrolled as healthy group. High-throughput 16S rDNA sequencing was used to analyze the structure of fecal bacterial communities, and Anosim, LEfSe software, and R language stats package were used to analyze the differences in the relative abundance, diversity, community, and evolutionary branching of intestinal flora between groups. The t-test was used for comparison of normally distributed continuous data with homogeneity of variance between groups, and the Kruskal-Wallis U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis. ResultsAt the phylum level, the dominant bacteria were Bacteroidetes and Firmicutes in each group, which accounted for ＞90% in the healthy group and ＞80% in the primary liver cancer group and the TACE treatment group. Bacteroidetes accounted for 48.44%, 44.96%, and 48.60%, respectively, in the healthy group, the primary liver cancer group, and the TACE treatment group, and Firmicutes accounted for 47.09%, 38.15%, and 3393%, respectively, in the three groups, suggesting that the primary liver cancer group had significantly lower relative abundance of Bacteroidetes and Firmicutes than the healthy group; in addition, the primary liver cancer group and the TACE treatment group had significantly higher relative abundance of Proteobacteria and Fusobacteria than the healthy group; although there were changes in the other phyla of bacteria, these bacteria accounted for ＜0.5%. Compared with the primary liver cancer group, the healthy group had significantly higher abundance and ACE value of observed species (abundance: 264±47 vs 230±64, t=2.499, P=0.014; ACE value: 284.11±50.82 vs 252.96±67.58, t=2.158, P=0.034). The rank between the primary liver cancer group and the healthy group was higher than that in each of the two groups (R＞0), so the difference in the structure of intestinal flora between the two groups was significantly greater than that within each of the two groups (P＜0.05). The rank between the pre-TACE group and the post-TACE group was lower than that in the pre-TACE group (R＜0), so the difference in the structure of intestinal flora within the pre-TACE group and the post-TACE group was greater than that between the two groups (P＞0.05). In the patients with primary liver cancer, intestinal opportunistic pathogens were correlated with Child-Turcotte-Pugh (CTP) score, total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) (r=0.245, 0.421, 0.327, and 0.446, P=0.049, P＜0.001, P=0.008, and P＜0.001), and potential probiotics were correlated with CTP score, TBil, albumin, ALT, and AST (r=-0.314, -0.490, 0.285, -0.374, and -0.528, P=0.011, P＜0.001, P=0.022, P=0.002, and P＜0.001). The abundance of the opportunistic pathogens among the differentially expressed bacteria increased with the increase in Child-Pugh class for liver function, and the patients with class C liver function had higher abundance than those with class A or B liver function (Z=4.301 and 4.063, P=0.038 and 0.044). The relative abundance of potential probiotics tended to decrease with the increase in Child-Pugh class for liver function, and the patients with class C liver function had lower abundance than those with class A liver function (Z=3.882, P=0.049). ConclusionThere are differences in the diversity and structure of intestinal flora between patients with primary liver cancer and healthy individuals, and the patients with primary liver cancer have similar intestinal flora before and after TACE, suggesting that TACE has little influence on intestinal flora. Intestinal dysbacteriosis is associated with the clinical classification of primary liver cancer, and the degree of intestinal dysbacteriosis increases with the increase in Child-Pugh class for liver function, with a reduction in potential probiotics and an increase in opportunistic pathogens.