结肠癌根治术后肠道菌群及益生菌干预对结肠癌预后的影响  

Effect of intestinal flora and probiotic intervention on prognosis in colon cancer patients after radical resection

作　　者：郭桂元[1] 黄子成[1] 林婵婵 黄志鹏 GUO Guiyuan;HUANG Zicheng;LIN Chanchan;HUANG Zhipeng(Department of Gastroenterology, Quanzhou First Hospital, Quanzhou, Fujian Province, 362000, Chin)

机构地区：[1]福建省泉州市第一医院消化内科,福建泉州362000

出　　处：《第三军医大学学报》2017年第23期2293-2298,共6页Journal of Third Military Medical University

摘　　要：目的考察结肠癌根治术后肠道菌群与结肠癌预后的关系,以及益生菌干预对结肠癌预后的影响。方法收集2010年4月至2013年4月在我院收治并确诊的Ⅱ期结肠癌患者185例,患者均接受根治术,按照实际接受的治疗方案分为益生菌干预组(80例)和益生菌未干预组(105例),选择同期健康体检者20例为对照组。收集术前和术后1个月粪便,采用荧光定量PCR检测粪便的乳酸杆菌属、双歧杆菌属、大肠杆菌和肠球菌属。分析结肠癌患者术后4年生存情况及与肠道菌群数量的关系。结果两组术前双歧杆菌属、乳酸杆菌属、大肠杆菌和肠球菌属差异无统计学意义(P>0.05),根治术后,双歧杆菌属、乳酸杆菌属、双歧杆菌属、大肠杆菌和肠球菌属均明显降低(P<0.05),益生菌干预组和益生菌未干预组的菌群术前、术后差异均无统计学意义(P>0.05)。4年随访,无1例失访。105例益生菌未干预组中存活90例(85.71%),15例(14.29%)死亡,其中14例为结肠癌转移死亡,1例为心血管病死亡。乳酸杆菌属(χ~2=6.700,P=0.035)和双歧杆菌属(χ~2=5.777,P=0.016)数量越高,大肠杆菌(χ~2=3.301,P=0.069)和肠球菌属(χ~2=4.780,P=0.029)数量越低,结肠癌患者4年生存时间越长。80例益生菌干预组中存活76例(95.00%),4例(5.00%)患者死亡,其中3例为结肠癌转移死亡,1例交通意外死亡。与益生菌未干预组比较,益生菌干预组的存活例数较多(χ~2=4.248,P=0.039),因结肠癌转移死亡例数较少(χ~2=4.997,P=0.025)。结论结肠癌根治术后,双歧杆菌属和乳酸杆菌属数量越高,大肠杆菌和肠球菌属数量越低,结肠癌的预后较好。给予益生菌干预可明显改善结肠癌根治术后患者的生存情况。Objective To investigate the relationship between intestinal flora and prognosis after radical resection for colon cancer, and determine the effect of probiotic intervention on the prognosis. Methods A total of 185 patients with identified stage Ⅱ colon cancer before radical resection admitted to our hospital from April 2010 to April 2013 were enrolled in the study. They were randomly divided into probiotic intervention group （n=80） and non-probiotic intervention group （n=105）. Another 20 healthy subjects who took physical examination at the same period served as the control group. Fluorescence quantitative PCR was used to detected Bifidobacterium, Lactobacillus, Escherichia coli and Enterococcus in stool samples before and in 1 month after operation. The relationship between the 4-year survival and the types and amounts of intestinal flora was analyzed. Results There were no significant differences in the amounts of Bifidobacterium, Lactobacillus, Escherichia coli and Enterococcus in the colon cancer patients before operation when compared with the control group （P〉0.05）. After radical resection, the amounts of Bifidobacterium, Lactobacillus, Bifidobacterium, Escherichia coli and Enterococcus were significantly decreased （P〈0.05）. Probiotic intervention had no effect on the types and amounts of intestinal flora in the patients no matter before or after surgery （P〉0.05）. No one lost during the 4 years’ followup. In the 105 cases receiving nonprobiotic intervention, 90 patients （85.71%） were survived and 15 （14.29%） died, including 14 cases due to colorectal cancer metastasis and 1 to cardiovascular disease. The higher amounts of E.coli （Chi-square=6.700, P=0.035） and Bifidobacterium （Chi-square=5.777, P=0.016）, and the lower amounts of Escherichia coli （Chi-square=3.301, P=0.069） and Enterococcus （Chi-square=4.780, P=0.029）, the survival time was longer in the follow-up. In the 80 cases receiving probiotic intervention, 76 cases （95.00%�

关 键 词：结肠癌根治术 肠道菌群 益生菌 预后 

分 类 号：R181.32[医药卫生—流行病学] R372[医药卫生—公共卫生与预防医学]