艰难梭菌感染对结直肠癌患者营养及代谢的影响  

Effect of clostridium difficile infection on nutrition and metabolism of patients with colorectal neoplasms

作　　者：童舟[1] 罗芸[2] 刘璐璐[1] 郑怡[1] 蒋微琴[1] 陈晓刚[3] 赵鹏[1] 金大智[2] 方维佳[1] 

机构地区：[1]浙江大学医学院附属第一医院肿瘤细胞生物治疗中心,浙江杭州310003 [2]浙江省疾病预防控制中心细菌检验科,浙江杭州310051 [3]浙江大学医学院附属第一医院检验科,浙江杭州310003

出　　处：《中华危重症医学杂志（电子版）》2016年第4期217-221,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：教育厅课题资助(Y201430628);国家自然科学基金(81472210;81471998;81472346);浙江省自然科学基金(LY15H160013;LQ14H160009);2015-2016年浙江省重点研发计划(2015C03048);浙江省医药卫生重大科技计划(WKJ-ZJ-1507)

摘　　要：目的探究艰难梭菌感染对结直肠癌患者营养及代谢的影响。方法留取205例肠癌患者术前粪便样本,根据有无艰难梭菌感染分成感染组(33例)及未感染组(172例),并在肿瘤浸润深度(T_1、T_2、T_3、T_4)、淋巴转移个数(N_0、N_1、N_2)、隐血试验等因素下,检测两组患者的白蛋白、总蛋白水平。同时,比较两组患者在是否超重(体质量指数≥24)及不同性别下的游离脂肪酸水平,并根据患者年龄是否≥60岁进一步分组比较游离脂肪酸水平。结果感染组T_4患者的白蛋白[(38±3)g/L vs.(41±5)g/L,t=2.211,P<0.05]和总蛋白[(63±7)g/L vs.(68±6)g/L,t=2.424,P<0.05]均较未感染组显著降低。且感染组隐血试验阳性患者的白蛋白[(38±5)g/L vs.(42±4)g/L,t=2.904,P<0.05]和总蛋白[(64±8)g/L vs.(68±6)g/L,t=2.537,P<0.05]水平较未感染组亦显著降低。而感染组N_2患者中仅总蛋白较未感染组显著降低[(64±5)g/L vs.(69±6)g/L,t=2.085,P<0.05]。感染组超重[(0.25±0.12)mmol/L vs.(0.38±0.21)mmol/L,t=3.191,P<0.05]及男性患者[(0.26±0.12)mmol/L vs.(0.37±0.20)mmol/L,t=3.239,P<0.05]的游离脂肪酸水平较未感染组显著下降,且年龄≥60岁的超重[(0.24±0.13)mmol/L vs.(0.38±0.22)mmol/L,t=2.143,P<0.05]及男性[(0.23±0.12)mmol/L vs.(0.37±0.21)mmol/L,t=3.392,P<0.05]感染者较未感染者的游离脂肪酸水平更低。结论艰难梭菌感染的T_4及隐血试验阳性的结直肠癌患者易引起白蛋白、总蛋白下降;超重、男性的老年感染患者更易出现脂肪代谢紊乱。Objective To evaluate the effect of Clostridium difficile infection （CDI） on nutrition and metabolism of patients with eolorectal cancer （CRC）. Methods Stool samples were collected from 205 preoperative CRC patients who were scheduled to have radical cancer resection. The samples were divided into the CDI group （33 cases） and non-CDI group （172 cases）. The levels of albumin and total protein at different T stage, N stage, occult blood （OB） test were detected, and the levels of free fatty acid in whether being overweighted [body mass index （BMI）≥ 24] and gender were measured. Meanwhile, the samples in BMI ≥24 and male were further divided into two subgroups according to the age whether ≥60 years old, and the levels of free fatty acid were compared. Results The levels of albumin [（38±3）g/L vs. （41 ±5）g/ L, t = 2.211, P 〈 0.05], total protein [（63 ± 7） g / L vs. （68 ± 6） g / L, t = 2.424, P 〈 0.05] at T4 （tumour penetrates the serosa） in the CDI group were much lower than those in the non-CDI group. The levels of albumin [（38±5）g/L vs. （42±4）g/L t=2.904, P〈0.05], total protein [（64±8） g/L vs. （68 ±6）g/L, t=2.537, P〈0.05] at OB positive in the CD1 group also decreased markedly as compared with the non-CDI group. However, the total protein levels only at N2 （lymph nodes metastasis more than 3） in the CDI group was much lower than those in the non-CDI group [（64 ± 5） g / L vs. （69 ± 6） g / L, t = 2.085, P 〈 0.05]. Meanwhile, the levels of free fatty acid at BMI t〉24 [（0.25 ± 0.12） mmol/L vs. （0.38 ± 0.21） mmol/L, t=3.191, P〈0.05] and male [（0.26± 0.12） mmol / L vs. （0.37 ± 0.20） mmol/ L, t = 3.239, P 〈 0.05] decreased markedly in the CDI group as compared with the non-CDI group. After further subgrouping, the levels of free fatty acid with age ≥ 60 years old at BMI t〉 24 [（0.24 ± 0.13） mmol / L vs. （0.38 ± 0.22） mmol / L, t = 2.143, P〈0.05] and male [（0.23 ± 0.12） mmol/L vs. �

关 键 词：艰难梭菌 结直肠癌 感染 代谢 

分 类 号：R735.34[医药卫生—肿瘤]