| Summary: | Objective To assess the effect of probiotic intervention on intestinal flora and immune status in patients with secondary infections to HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A total of 101 patients with HBV-ACLF treated in our hospital between January, 2017 and June, 2018 were enrolled in this study, including 56 without secondary infections (HBV-ACLF group) and 45 with secondary infections to HBV-ACLF (secondary infection group), with 67 healthy participants as controls. All the patients with HBV-ACLF were treated with bifidobacterium quadruple live bacteria tablets in addition to the routine treatments for 1 month. From all the participants, fecal specimens were collected before and after the treatment to analyze the changes in Lactobacillus, Bifidobacterium, Escherichia coli, Enterococcus, yeast, Staphylococcus, Bacteroides and Streptococcus mutans; peripheral blood samples were also obtained for testing the serum levels of immunoglobulin A (IgA), IgG and IgM using ELISA; the changes in T lymphocyte subsets CD3+, CD4+ and CD8+ were detected using immunofluorescence flow cytometry, and the levels of C-reactive protein (CRP), tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and interleukin-8(IL-8) were determined using ELISA. Results Compared with the control group, the patients with HBV-ACLF in both groups before the treatment showed significantly reduced abundance of intestinal Lactobacilli and Bifidobacteria and increased abundance of Escherichia coli, Enterococcus, yeast, Staphylococcus, Bacteroides, and Streptococcus pneumoniae (P < 0.05), with significantly lowered levels of IgA, IgG, IgM, NK, CD4+ and CD4+/CD8+ (P < 0.05) and elevated levels of CRP, TNF-α, IL-6 and IL-8 (P < 0.05); These changes were even more obvious in patients with secondary infections than in those without infections (P < 0.05). After the treatment, the intestinal Lactobacilli, Bifidobacteria and blood levels of IgA, IgG, IgM, NK, CD4+ and CD4+/CD8+ increased significantly (P < 0.05), and intestinal Escherichia coli, Enterococcus, yeast, Staphylococcus, Bacteroides, Streptococcus pneumoniae and the levels of CRP, TNF-α, IL-6 and IL-8 were all decreased in both HBV-ACLF group and the secondary infection group (P < 0.05). No significant differences in CD3+ or CD8+ cells were found among the 3 groups either before or after the treatment (P>0.05). Conclusion The patients with secondary infections to HBV-ACLF have abnormal changes in intestinal flora and immune status, which can be improved by probiotic intervention.
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