Bajaj Jasmohan S, Khoruts Alexander
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
Division of Gastroenterology Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota, USA.
J Hepatol. 2020 May;72(5):1003-1027. doi: 10.1016/j.jhep.2020.01.017. Epub 2020 Jan 28.
Patients with chronic liver disease and cirrhosis demonstrate a global mucosal immune impairment, which is associated with altered gut microbiota composition and functionality. These changes progress along with the advancing degree of cirrhosis and can be linked with hepatic encephalopathy, infections and even prognostication independent of clinical biomarkers. Along with compositional changes, functional alterations to the microbiota, related to short-chain fatty acids, bioenergetics and bile acid metabolism, are also associated with cirrhosis progression and outcomes. Altering the functional and structural profile of the microbiota is partly achieved by medications used in patients with cirrhosis such as rifaximin, lactulose, proton pump inhibitors and other antibiotics. However, the role of faecal or intestinal microbiota transplantation is increasingly being recognised. Herein, we review the challenges, opportunities and road ahead for the appropriate and safe use of intestinal microbiota transplantation in liver disease.
慢性肝病和肝硬化患者存在全身性黏膜免疫损伤，这与肠道微生物群的组成和功能改变有关。这些变化随着肝硬化程度的加重而进展，并且可与肝性脑病、感染甚至预后相关，而与临床生物标志物无关。除了组成变化外，微生物群的功能改变，如与短链脂肪酸、生物能量学和胆汁酸代谢相关的改变，也与肝硬化的进展和结局有关。改变微生物群的功能和结构特征部分是通过肝硬化患者使用的药物来实现的，如利福昔明、乳果糖、质子泵抑制剂和其他抗生素。然而，粪便或肠道微生物群移植的作用越来越受到认可。在此，我们综述了在肝病中合理、安全使用肠道微生物群移植所面临的挑战、机遇及未来方向。
