粪菌移植疗法治疗晚期结直肠癌FOLFIRI化疗方案相关难治性腹泻的效果观察  

Clinical Efficacy of Fecal Microbiota Transplantation Therapy in the Treatment of Refractory Diarrhea Associated with FOLFIRI Chemotherapy Regimen for Advanced Colorectal Cancer

作　　者：桂冠 易健 张善金 谢萍 UI Guan;YI Jian;ZHANG Shanjin;XIE Ping(Yichun City People’s Hospital,Yichun 336000,China;不详)

机构地区：[1]江西省宜春市人民医院,江西宜春336000

出　　处：《中国医学创新》2021年第30期10-14,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(20204739)。

摘　　要：目的:观察粪菌移植疗法治疗晚期结直肠癌FOLFIRI化疗方案相关难治性腹泻的临床效果,并探讨治疗机制。方法:选取2019年7月-2021年5月本院收治的62例晚期结直肠癌FOLFIRI方案化疗后出现难治性腹泻(Ⅲ级以上腹泻)的患者,根据治疗方式将患者分为粪菌移植组(n=30)与常规治疗组(n=32)。常规治疗组采用常规综合营养支持治疗;粪菌移植组患者需采集粪便样本,进行16S rDNA测序,将测序结果以及患者临床信息放入大数据库中进行供受体配型;配型成功后,将所配型成功的供体制备的健康粪便细菌移植到患者体内,移植1个疗程(常规推荐一个疗程移植3次,每次移植菌液200 mL,隔天移植一次)。比较两组消化道不良症状、炎性因子的表达、肠黏膜通透性及肠道菌群的差异。结果:与常规治疗组对比,粪菌移植组腹泻发生率更低,腹泻、恶心呕吐、食欲减退评分均更低(P<0.05)。两组治疗前炎性因子水平对比,差异均无统计学意义(P>0.05);粪菌移植组治疗后血清IL-6水平低于常规治疗组,IL-10高于常规治疗组,差异均有统计学意义(P<0.05)。两组治疗前肠黏膜通透性对比,差异均无统计学意义(P>0.05);粪菌移植组治疗后粪便中血浆二胺氧化酶、D-乳酸及内毒素水平均低于常规治疗组(P<0.05)。两组治疗前肠道微生物菌群功能对比,差异均无统计学意义(P>0.05);治疗后粪菌移植组双歧杆菌、乳酸杆菌计数均多于常规治疗组,而大肠埃希菌、肠球菌计数均少于常规治疗组,差异均有统计学意义(P<0.05)。结论:粪菌菌群移植治疗晚期结直肠癌FOLFIRI化疗方案相关难治性腹泻,有良好的效果,可降低炎性因子水平与临床症状评分,同时可改善肠道微生物菌群功能,值得广泛应用。Objective:To observe the clinical effect of fecal bacteria transplantation in the treatment of refractory diarrhea associated with FOLFIRI chemotherapy regimen in advanced colorectal cancer,and to explore the treatment mechanism.Method:A total of 62 patients with refractory diarrhea (diarrhea above grade Ⅲ) after FOLFIRI chemotherapy for advanced colorectal cancer treated in our hospital from July 2019 to May 2021 were selected as the objects,the patients were divided into fecal bacteria transplantation group (n=30) and routine treatment group (n=32).The routine treatment group was treated with routine comprehensive nutritional support,patients in fecal bacteria transplantation group needed to collect fecal samples for 16S rDNA sequencing,and put the sequencing results and patient clinical information into a large database for donor recipient matching.After successful matching,the healthy fecal bacteria prepared by the successfully matched donor were transplanted into patients,one course of transplantation (it is generally recommended to transplant three times in a course of treatment,200 mL bacterial solution each time,and once every other day).The symptoms of dyspepsia,the expression of inflammatory factors,intestinal mucosal permeability and intestinal flora were compared between two groups.Result:Compared with the routine treatment group,the incidence of diarrhea in the fecal bacteria transplantation group was lower,the scores of diarrhea,nausea,vomiting and anorexia in the fecal bacteria transplantation group were lower (P<0.05).There were no significant differences in the levels of inflammatory factors between two groups before treatment (P>0.05);the level of serum IL-6 in the fecal bacteria transplantation group was lower than that in the routine treatment group,and IL-10 was higher than that in the routine treatment group (P<0.05).There were no significant differences in intestinal mucosal permeability between two groups before treatment (P>0.05);the plasma diamine oxidase,D-lactic acid and endotoxin wa

关 键 词：菌群移植 结直肠癌 FOLFIRI方案 化疗相关性腹泻 

分 类 号：R735.34[医药卫生—肿瘤]