恶性血液病患者化疗后并发感染与机体免疫功能及肠道微生态的关系  

Relationship between development of an infection after chemotherapy and immune function and intestinal microecology in patients with a hematologic malignancy

作　　者：曹海武[1] 赵晓红[1] 陆时运[1] 柳萍[1] 王智[1] CAO Hai-wu ZHAO Xiao-hong LU Shi-yun LIU Ping WANG Zhi(Hematology, Wuxi Second People＇s Hospital affiliated with Nanjing Medical University, Jiangsu, Wuxi 214002, China)

机构地区：[1]南京医科大学附属无锡市第二人民医院血液科,江苏无锡214002

出　　处：《中国病原生物学杂志》2017年第5期456-459,共4页Journal of Pathogen Biology

摘　　要：目的分析恶性血液病患者化疗前后机体免疫功能和肠道菌群的变化,探讨机体免疫功能及肠道微生态与化疗后并发感染的相关性。方法选择2012年1月-2015年12月无锡市第二人民医院收治的120例首发恶性血液病且需要化疗的患者,根据化疗后是否发生感染分为感染组(44例)和无感染组(76例)。于化疗前后留取患者血样和粪便标本,检测血液相关免疫细胞水平及粪便标本中分泌性免疫球蛋白A(sIgA)水平;分析肠道菌群变化,以双歧杆菌与肠杆菌的数量比值(B/E值)评价肠道定植抗力(CR)。结果化疗后,感染组患者外周血白细胞[(2.26±0.55)109/L]、中性粒细胞[(0.61±0.04)109/L]、CD3+[(25.51±3.23)%]、CD4+[(13.62±4.53)%]、CD4+/CD8+[(0.59±0.22)%]及sIgA水平[(0.58±0.07)g/L]均显著低于化疗前(t分别为-33.737、-55.831、-15.019、-11.182、-13.007、-28.387,P均<0.05)和化疗后无感染组(t分别为-14.947、-74.774、-10.845、-4.661、-5.447、-21.696,P均<0.05);与化疗前比,化疗后感染组患者粪便标本肠杆菌[(9.97±1.01)lg CFU/g]、肠球菌[(9.88±0.55)lg CFU/g]、不动杆菌[(7.84±0.70)lg CFU/g]、假单胞细菌[(5.11±0.89)lg CFU/g]及真菌[(9.54±0.87)lg CFU/g]菌落数显著增多(t分别为8.205、4.876、6.791、7.028、6.588,P均<0.05),双歧杆菌[(5.24±0.37)lg CFU/g]和乳酸杆菌[(2.37±0.36)lg CFU/g]菌落数显著减少(t分别为-13.358、-48.641,P均<0.05);且感染组较无感染组肠球菌、不动杆菌及真菌菌落数增加及双歧杆菌和乳酸杆菌菌落数减少更显著(t分别为3.717、6.510、5.384、-5.103、-11.028,P均<0.05);感染组化疗后B/E值(0.53±0.07)显著小于化疗前(t=-12.903,P<0.05)和无感染组化疗后(t=-6.131,P<0.05)。结论恶性血液病患者化疗后机体免疫功能下降,肠道菌群紊乱,CR下降,造成免疫稳态失衡,患者发生感染的风险增加。Objective To analyze changes in immune function and intestinal flora in patients with a hematologic malig-nancy before and after chemotherapy and to examine the relationship between immune function and intestinal microecology and development of an infection after chemotherapy. Methods Subjects were 120 patients who initially developed a he- matologic malignancy and who underwent chemotherapy at Wuxi No. 2 People＇s Hospital from January 2012 to December 2015. Patients were divided into an infected group （44 patients） and an uninfected group （76 patients） depending on whether or not they developed an infection after chemotherapy. Blood and stool specimens were collected before and after chemotherapy. Levels of immunocytes in blood and secretory immunoglobulin A （sIgA） in stool specimens were meas- ured, and changes in intestinal flora were analyzed. Colonization resistance （CR） was evaluated based on the ratio of bifidobacteria to Escherichia coli （B/E）. Results The white blood cell count （WBC） [-2.26-t-0.55 109/L-, neutrophil （NP） count [-0.61±0.04 109/L], CD3＋ count （25. 51±3. 23）%, CD4＋ count （13. 62±4.53）%, and CD4＋/CD8＋ （0.59±0.22） % in blood and the level of sIgA （0.58±0.07）g/L in stool specimens decreased significantly after chemo- therapy in comparison to the corresponding values before chemotherapy （t= - 33. 737, - 55. 831, - 15. 019, - 11. 182, -13.007, -28.387, P〈0.05）. The WBC, NP count, CD3＋ count, CD4＋ count, and CD4＋/CD8＋ in blood and the level of slgA in stool specimens were markedly higher in the infected group than corresponding values in the uninfected group （t= -14. 947, -74. 774, -10. 845, -4. 661, -5. 447, -21. 696, P〈0.05）. The number of E. coli （9.97± 1.01） lg CFU/g, Enteroeoccus （9.88±0.55） lg CFU/g, Acinetobacter （7.84±0.70） lg CFU/g, Pseudomonas （5.11±0.89） lg CFU/g, and fungi （9.54±0.87） lg CFU/g markedly increased after chemotherapy （t= 8. 205, 4. 876, 6. 791, 7. 028, 6. 588, P〈0.

关 键 词：恶性血液病 感染 免疫 肠道微生态 化疗 

分 类 号：R552[医药卫生—血液循环系统疾病]