Clinical Parameters and Gut Microbiome Changes Before and After Surgery in Thoracic Aortic Dissection in Patients with Gastrointestinal Complications

Shuai Zheng,Zhiyu Qiao,Jie Du,Xue Chen,Shulin Shao,Ying Yu,Jie Zhang,Feng Gao,Chunmei Piao

doi:10.1038/s41598-017-15079-0

Abstract

Thoracic aortic dissection (TAAD) is one of the most common types of aortic diseases. Although surgery remains the main method of treatment, the high rate of postoperative gastrointestinal complications significantly influences the effects of surgery and the recovery process. Moreover, the mechanisms underlying this disease remain unclear. To address these problems, we examined changes in the gut microbiota in 40 thoracic aortic dissection patients with abdominal complications after surgery. Levels of white blood cells (WBC), neutrophile granulocytes (NE), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were higher in all patients after surgery. Levels of inflammatory cytokines, including interleukin (IL)-2, IL-6, IL-8, and IL-10, were also higher after surgery. A metagenome analysis revealed that levels of Oscillibacter, Anaerotruncus, Alistipes, and Clostridium difficile were higher after the operation. The abundance of functional genes, such as the spermidine/putrescine transport system permease protein, the flagellar motor switch protein, and branched-chain amino acid transport system proteins, was also higher post-surgery. These changes likely contribute to diarrhea, bloating, gastrointestinal bleeding, and other abdominal complications after surgery, and our research opens up new treatment possibilities for patients suffering from abdominal complications after surgical treatment.

Highlights

Surgical intervention is suggested for treating Stanford Type A aortic dissection[2], and is still the preferred method for such kind of AD3, and anti-hypertensive treatment should begin at the occurrence of systemic hypertension
white blood cells (WBC), neutrophile granulocytes (NE), AST, and ALT levels were significantly higher in plasma after surgery (Table 1), indicating systemic inflammation as well as liver injury
enzyme-linked immunosorbent assay (ELISA) on blood samples revealed that inflammatory cytokines, including IL-2, IL-6, and IL-10, had a tendency to increase after surgery, the difference was not significant (Fig. 1)

Summary

Introduction

Surgical intervention is suggested for treating Stanford Type A aortic dissection[2], and is still the preferred method for such kind of AD3, and anti-hypertensive treatment should begin at the occurrence of systemic hypertension. One of the more serious complications after aortic surgery is gastrointestinal complications (GICs)[5]. In follow-up, 70–80% of postoperative patients were found to have GICs such as diarrhea, abdominal distention, difficulty defecating, gastrointestinal bleeding, and other digestive system complications (unpublished data). Gut microbiota should be taken as a sign and treatment target for complications after AD surgery. There are no reports on changes in gut microbiota in AD patients. We characterized changes in the gut microbiome in AD patients with GICs after surgery using high-throughput sequencing. We evaluated the systemic inflammatory response in postoperative patients and determined its correlation with changes in the microbiota.

Methods

Results

Conclusion