摘要目的:探讨肝硬化营养不良患者的肠道菌群组成及特点，从而为从肠道菌群角度干预肝硬化患者营养不良提供依据。方法:采用断面研究，收集72例肝硬化患者及30例健康对照者。采用16 s rRNA测序方法，对健康对照者和肝硬化患者的肠道菌群特点进行分析，根据主观全面评估法(subjective global assessment，SGA)来检测肝硬化患者的营养状况。营养良好的肝硬化患者分为SGA-A组，营养不良的肝硬化患者分为SGA-B/C组。结果:肝硬化组Shannon指数明显低于健康对照组( P＝0.032)，SGA-A组Shannon指数明显低于SGA-B/C组( P＝0.009)。在门水平，相对于SGA-A组相比，SGA-B/C组厚壁菌门相对丰度明显降低( P＝0.022)，变形菌门明显增高( P＝0.011)。在属水平，SGA-B/C组中相对丰度降低最明显的3个菌属均为生产短链脂肪酸菌属，分别是 Odoribacter(目前没有正式的中文名)、厌氧棍状菌属( Anaerotruncus)、粪球菌属( Coprococcus)，均为 P<0.05；明显增加的是埃希氏菌-志贺氏菌属( Escherichia/ Shigella)， P＝0.045。 结论:肝硬化患者的营养不良和肠道菌群结构改变相关，表现为生产短链脂肪酸的菌属减少，条件致病菌增加。该研究结果为从肠道菌群角度进一步改善肝硬化患者营养状况的干预措施提供了依据。

abstractsObjective:To investigate the characteristics of intestinal flora in malnourished patients with cirrhosis and to provide evidence for invention of patients with cirrhosis from intestinal flora aspect.Methods:To use a cross-sectional study. Seventy-two patients with cirrhosis and 30 healthy controls were collected. The intestinal flora of healthy controls and patients with cirrhosis were analyzed by 16 s rRNA sequencing method. The nutritional status of patients was assessed by subjective global assessment (SGA), with SGA-A for well nutrition and SGA-B/C for malnutrition.Results:The Shannon index of the cirrhosis group was significantly lower than that of the healthy control group ( P=0.032), and that of the SGA-A group was significantly lower than that of the SGA-B/C group ( P=0.009). At the phylum level, compared with the SGA-A group, the relative abundance of Firmicutes in the SGA-B/C group was significantly reduced ( P=0.022), and the Proteobacteria significantly increased ( P=0.011). At the genus level, the three most significant relative abundance decreases in the SGA-B/C group were Odoribacter, Anaerotruncus, Coprococcus(all P<0.05), which were all bacteria that produced short-chain fatty acids, and Escherichia/ Shigella significantly increased ( P=0.045). Conclusions:Malnutrition in patients with cirrhosis (SGA-B/C) was associated with changes in intestinal flora, characterized by a decrease in the number of bacteria producing short-chain fatty acids and an increase in the number of pathogenic bacteria. It provides a basis for the intervention measures to further improve the nutritional status of patients with cirrhosis.