结肠炎相关性肠癌患者肠道菌群紊乱及肠道黏膜损伤情况分析  

Analysis of intestinal flora disorder and intestinal mucosal damage in patients with colitis-associated cancer

作　　者：康发财 赵书红 陈思桢 孙必达 KANG Facai;ZHAO Shuhong;CHEN Sizhen;SUN Bida(Department of Gastroenterology,Zhoushan Branch of Shanghai Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Zhoushan 316000,China)

机构地区：[1]上海交通大学医学院附属瑞金医院舟山分院消化内科,浙江舟山316000

出　　处：《健康研究》2022年第5期578-582,F0003,共6页Health Research

摘　　要：目的 分析溃疡性结肠炎及结肠炎相关性肠癌患者的肠道菌群紊乱和肠道黏膜损伤情况。方法 回顾性分析152例溃疡性结肠炎(活动期组83例、缓解期组69例)及63例结肠炎相关性肠癌(结肠癌组)患者的临床资料,另选取同期70例健康体检者(健康组),对比各组肠道菌群失调程度、菌落变化、内镜下肠道黏膜损伤情况及组织活检结果。结果 研究对象的肠道菌群失调程度随肠道病变加重依次增加,肠杆菌、肠球菌、消化球菌、小梭菌密度依次升高,双歧杆菌、乳杆菌密度依次降低,各组间差异均有统计学意义(P<0.05)。与健康者肠道组织形态相比,缓解期组轻度黏膜水肿,组织染色可见少量中性粒细胞,累及少量隐窝;活动期组肠道黏膜水肿、溃疡性病变,黏膜腺体萎缩变形,炎症病变加重;结肠癌组患者肠道重度水肿、溃烂,黏膜腺体扭曲变形、萎缩,大部分区域可见淋巴滤泡增生及隐窝脓肿;各组随着肠道病变程度增加,肠道内镜分级增加,组间比较差异均具有统计学意义(P<0.05)。结论 肠道菌群紊乱及内镜不规则性溃疡和狭窄可能提示结肠发生炎性病变,临床可根据内镜及活检组织学观察判断结肠炎病变范围及程度,合理制定治疗方案。Objective To analyze the intestinal flora disorder and intestinal mucosal damage in patients with ulcerative colitis and colitis-associated colon cancer.Methods The clinical data of 152 cases of ulcerative colitis(83 cases in active phase,69 cases in remission phase) and 63 cases of colitis-associated carcinoma(colon cancer group) were analyzed retrospectively.Another 70 health examinees(healthy group) in the same period were selected.The degree of intestinal flora imbalance,colony change,intestinal mucosa damage under endoscopy,and tissue biopsy results in each group were compared.Results The degree of imbalance of intestinal flora of the subjects increased with the aggravation of intestinal disease,the densities of enterobacteria,enterococcus,enterococcus,and clostridium perfringens increased in turn,and the densities of bifidobacteria and lactobacillus decreased in turn.There were significant differences between groups(P<0.05).Compared with the intestinal tissue morphology of healthy subjects,in remission phase,slight mucosal edema,a small number of neutrophils,and a small number of crypts were found in tissue staining;in active phase,intestinal mucosa had edema and ulcerative lesions,mucosal glands atrophy and deform,and inflammatory lesions worsen.In colon cancer group,patients had severe intestinal edema and ulceration,mucosal glands distorted,deformed and atrophied,and lymphoid follicular hyperplasia and crypt abscess were seen in most areas.With the increase of intestinal disease degree,the intestinal endoscopy grading increased in each group,and the differences between groups were statistically significant(P<0.05).Conclusions Intestinal flora disorder and endoscopic irregular ulcer and stenosis may indicate the occurrence of inflammatory lesions in the colon.The scope and extent of colitis lesions can be judged according to endoscopic and biopsy histological observations,and a reasonable treatment plan can be formulated.

关 键 词：结肠炎相关性肠癌 肠道菌群紊乱 菌落失调 肠道黏膜损伤 内镜分级 

分 类 号：R735[医药卫生—肿瘤]