Abstract: Objective To investigate the characteristics of gut microbiota in patients with primary liver cancer (PLC) and the predictive efficacy of serum total bile acid (TBA), glucose regulatory protein 78 (GRP78), and myeloperoxidase (MPO) on their gut microbiota dysbiosis. Methods Ninety PLC patients who received treatment in our hospital from January 2020 to February 2023 were selected as the PLC group, and were separated into dysbiosis group (n=38) and non-dysbiosis group (n=52) based on whether the patient had gut microbiota dysbiosis. Additionally, 90 healthy individuals who underwent physical examination during the same period were included as the control group. The quantity and characteristics of gut microbiota in the PLC group and control group were measured and analyzed. Enzyme colorimetric method was applied to detect serum TBA level. Enzyme linked immunosorbent assay (ELISA) was applied to detect serum levels of GRP78 and MPO. Multivariate logistic analysis was applied to analyze the factors affecting gut microbiota imbalance in PLC patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive efficacy of serum TBA, GRP78, and MPO for gut microbiota dysbiosis in PLC patients. Results The numbers of bifidobacteria and lactobacilli in the PLC group were lower than those in the control group [(8.12±2.23) vs (12.59±2.71) 1gCFU/g, (6.53±1.47) vs (17.04±4.02) 1gCFU/g, all P<0.001], while the numbers of Enterococcus and Enterobacterium were higher than those in the control group [(12.32±2.43) vs (6.75±0.79) 1gCFU/g, (16.56±3.49) vs (7.02±1.68) 1gCFU/g, all P<0.001]. Compared with the control group, the expression levels of serum TBA, GRP78, and MPO in the PLC group showed an upward trend [(42.57±9.32) vs (3.12±1.05) μmol/L, (154.33±21.54) vs (60.13±14.42) ng/mL, (24.79±2.59) vs (9.12±1.67) mg/L, all P<0.001]. The expression levels of serum TBA, GRP78, and MPO in the dysbiosis group were obviously higher than those in the non dysbiosis group [(50.14±9.53) vs (37.03±8.86) μmol/L, (174.64±23.64) vs (139.48±17.35) ng/mL, (26.98±2.85) vs (23.19±2.46) mg/L, all P<0.001]. Serum TBA, GRP78, and MPO were all factors that affected the occurrence of intestinal microbiota imbalance in PLC patients (P<0.05). The area under the curve (AUC) of serum TBA, GRP78, MPO, and their combined prediction for gut microbiota dysbiosis in PLC patients was 0.893, 0.933, 0.859, and 0.984, respectively. The combined predictive efficacy of the three indicators was higher than that of the three indicators alone (Z_{triple combination-TBA}=3.133, Z_{triple combination-GRP78}=2.147, Z_{triple combination-MPO}=3.266, all P<0.05). Conclusion The numbers of Bifidobacterium and Lactobacillus in PLC patients decrease, while the numbers of Enterococcus and Enterobacterium increase. The serum levels of TBA, GRP78, and MPO also increase, and these three factors are closely related to intestinal dysbiosis and may serve as biological indicators for predicting the occurrence of intestinal dysbiosis in PLC patients.

Key words: Primary liver carcinoma, Total bile acid, Glucose-regulated protein 78, Myeloperoxidase, Intestinal microbiota