VALUE OF GUT MICROBIOTA CHANGES AND 1GER/1GFP IN PATIENTS WITH CHRONIC LIVER DISEASE IN DIAGNOSING LIVER CANCER

Zhihong Xie, Jiayi Wu^*

Department of Infectious Diseases, Affiliated Hospital of Huzhou Teacher's College, The First Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China

Objective: To investigate whether the gut microbiota, specifically the logarithmic ratio of Eubacterium rectum to Faecalibacterium prausnitzii (IgEr/IgFp), can be used as a biomarker for liver cancer in patients with chronic liver disease.

Methods: A total of 152 patients with liver disease (cirrhosis, n=58; liver cancer, n=42; chronic liver disease, n=52) and 40 healthy patients receiving a regular check-up in our hospital from January 2019 to January 2020 were recruited. A 2 g stool sample was collected from each participant, and the gut microbiota distribution was measured using quantitative fluorescence PCR. Fasting venous blood samples (4 ml) were collected from all participants, and alpha-fetoprotein (AFP) levels were determined using chemiluminescence immunoassay. In addition, albumin (ALB), globulin (GLB), and cholinesterase (CHE) levels were detected using immunoturbidimetric assay. The factors associated with a diagnosis of liver cancer were analyzed using single factor logistics regression, and the use of 1gEr/1gFp and AFP as biomarkers for the diagnosis of liver cancer was assessed using the receiver operating characteristic curve.

Results: There were significant group differences in levels of Faecalibacterium prausnitzii, Enterococcus, Bacteroides, Lactobacillus, Bifidobacterium, Clostridium tenuisii, Eubacterium rectum, and Enterobacter between chronic liver disease group, liver cancer group, cirrhosis group, and controls (P<.05). Similarly, the 1gEr/1gFp ratio was significantly different between groups. The differences in AFP, ALB, GLB, and CHE were statistically significant between the chronic liver disease group, liver cancer group, and cirrhosis group (P<.05). In the univariate logistic regression analysis, the patient's liver cancer was taken as the outcome variable, and gut microbiotas and AFP were independent variables. The findings suggested that Faecalibacterium prausnitzii and Eubacterium rectum are significantly better biomarkers for liver cancer than AFP – at least in this cohort. The findings of a single factor regression analysis of the 1gEr/1gFp ratio found that it was significantly better at diagnosing and differentiating liver cancer (P<.01). The findings of the ROC curve analysis showed that the AUC for diagnosing liver cancer of the 1gEr/1gFp ratio was 0.748, and its best cut-off value was 0.965; the sensitivity at this point was 82.15%, and the specificity was 84.91%. The AUC of AFP was 0.665, its best cut-off value was 31.71 ng/ml, the sensitivity at this point was 65.12%, and the specificity was 67.10%. The AUC of combining them was 0.812, the sensitivity was 81.27%, and the specificity was 79.35%.

Conclusion: The structure of the gut microbiota distribution in patients with liver cirrhosis, liver cancer, and chronic liver disease was significantly altered. Among them, the beneficial bifidobacteria was significantly reduced, and harmful bacteria were significantly increased. The 1gEr/1gFp ratio was significantly better than AFP in diagnosing liver cancer and can be widely used in clinical practice.