Schulz Christian, Schütte Kerstin, Vilchez-Vargas Ramiro, Vasapolli Riccardo, Malfertheiner Peter
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-Von-Guericke University Magdeburg, Magdeburg, Germany.
Klinikum der LMU München-Grosshadern, Medizinische Klinik 2, München, Germany.
Dig Dis. 2019;37(2):161-169. doi: 10.1159/000494216. Epub 2018 Nov 14.
Gut microbiota play an essential role in the pathogenesis of hepatic encephalopathy (HE). Treatment strategies are directed to modulate intestinal microbiota profiles and their function by the administration of the non-absorbable disaccharide lactulose and the non-absorbable antibiotic rifaximin, which are required for long terms, but little is known on their long-term effect on gut microbiota composition and function.
To characterize the active bacterial assemblages in duodenum and faeces in patients with minimal HE (MHE) before, during and after long-term therapy with rifaximin.
We analysed the microbiota composition in 5 patients with liver cirrhosis and MHE treated either with rifaximin 550 mg bid alone continuously for a period of 3 months or combined with lactulose 30-60 mL daily for 3 months. In addition to clinical assessments of HE, biopsies from duodenum and stool samples were analysed for their specific bacterial community applying NGS after RNA isolation before treatment, after 3 months of treatment and 3 months after the end of treatment.
All 5 patients had a significant improvement of their MHE. Bacterial communities were different and distinct in duodenal samples and faeces. No statistically significant changes were found in the bacterial community profile at the different time points.
Rifaximin therapy with and without lactulose over a period of 3 months does not affect the bacterial community composition. The improvement of HE with rifaximin is lasting also after the end of treatment and therefore a prolonged effect on microbiota metabolic function is suggested.
肠道微生物群在肝性脑病（HE）的发病机制中起重要作用。治疗策略旨在通过给予不可吸收的二糖乳果糖和不可吸收的抗生素利福昔明来调节肠道微生物群谱及其功能，这些治疗需要长期进行，但它们对肠道微生物群组成和功能的长期影响知之甚少。
对轻度肝性脑病（MHE）患者在长期使用利福昔明治疗前、治疗期间和治疗后十二指肠和粪便中的活性细菌群落进行特征分析。
我们分析了5例肝硬化合并MHE患者的微生物群组成，这些患者单独连续3个月每日两次服用550mg利福昔明，或联合每日30 - 60mL乳果糖治疗3个月。除了对HE进行临床评估外，在治疗前、治疗3个月后和治疗结束后3个月，对十二指肠活检组织和粪便样本进行RNA分离后，应用二代测序（NGS）分析其特定细菌群落。
所有5例患者的MHE均有显著改善。十二指肠样本和粪便中的细菌群落不同且有差异。在不同时间点的细菌群落谱中未发现统计学上的显著变化。
为期3个月的利福昔明单独或联合乳果糖治疗不影响细菌群落组成。利福昔明治疗结束后，HE的改善仍然持续，因此提示对微生物群代谢功能有延长作用。
