不同处理因素对直肠癌病人围手术期肠道菌群影响

EFFECT OF DIFFERENT MANAGEMENTS ON THE GUT MICROBIOTA IN PERIOPERATIVE PATIENTS WITH RECTAL CANCER

目的探讨抗生素、术前肠道准备及术后饮食对直肠癌病人围手术期肠道菌群变化的影响。方法将40例直肠癌病人随机分为4组,对照组(Ⅰ组)、非肠道准备组(Ⅱ组)、非肠道准备+术后非禁饮食组(Ⅲ组)、非肠道准备+术后非禁饮食组+术后抗生素限制组(Ⅳ组),围手术期分别采用相应的措施处理,收集病人手术前后粪便标本,接种于大肠杆菌、类杆菌、双歧杆菌、乳酸杆菌、肠球菌、消化链球菌6种选择性培养基平板上进行培养,按平板活菌计数法计数细菌数量,比较各组手术前后肠道菌群变化。结果各组病人术后肠道菌群较术前均发生明显变化,细菌总数显著减少(t=14.784,P<0.05),大肠杆菌计数显著增加(t=21.727,P<0.05),而双歧杆菌、消化链球菌、乳酸杆菌、类杆菌、肠球菌则明显减少(t=13.894～95.802,P<0.05),且杆球比显著紊乱(t=20.963,P<0.05)。Ⅲ组术后各种细菌水平均低于Ⅳ组(F=9.487～483.350,P<0.05),杆球比高于Ⅳ组(F=483.350,P<0.05)。与Ⅱ组比较,Ⅰ组术后类杆菌、消化链球菌水平下降(F=42.307～169.877,P<0.05),杆球比下降(F=483.350,P<0.05)。与Ⅲ组比较,Ⅱ组术后类杆菌、肠球菌、双歧杆菌及细菌总数明显降低(F=9.487～169.877,P<0.05),杆球比下降(F=483.350,P<0.05)。结论应用抗生素、肠道准备及术后禁饮食不同程度地影响直肠癌病人围手术期肠道菌群,容易导致肠道微生态失衡;术后早期进食对肠道微生态有改善作用。

Objective To investigate the effect of antibiotics, bowel preparation, and postoperative drink and food on gut rnicrobiota in perioperative patients with rectal cancer. Methods Forty patients with rectal cancer were divided into four groups in random group 1 （control group）, group 2 （bowel preparation）, group 3 （non-bowel preparationS-non-postoperative fasting）, and group 4 （non-boweI preparation＋non-postoperative fgastingq-postoperative antibiotics-restricted）. Corresponding measures were adopted in perioperation, preoperative stool was collected and inoculated to E. coli, Bacteroides, Bifidobacterium, Lactobacil- lus, Enterococcus, and peptostreptococcus on selective culture plate and cultured. Changes of gut flora among the four groups were compared. Results Postoperatively, the microbial population in each group changed significanly as compared with before sur- gery, general bacterial population obviously decreased （t= 14. 784, P〈0.05）, E. coli counts increased （t= 21. 727, P〈0. 05）, while bifidobacteria, Peptostreptococcus, Lactobacillus, Bacteroides and Enterococcus reduced （t= 13. 894-- 95. 802, P〈0.05）, and bacillus/coccus ratio disordered （t= 20. 963, P〈0.05）. Compared with group 3, the count of various kinds of bacteria was fewer than that in group 4 （F=9. 487--483. 350, P〈0.05）, and the bacillus/coccus ratio was higher （F= 483. 350,P%0.05）. Compared with group 2, Bacteroides and peptostreptococcus level in group 1 （F= 42. 307--483. 350, P〈0.05）, and bacillus/coc- cus ratio declined （F= 483. 350, P% 0.05）. Compared with group 3, postoperative Bacteroides, enterococcus, bifidobacteria level and bacillus/coccus ratio in group 2 dropped markedly （F=9. 487--483. 350,P〈0.05）. Conclusion Application of antibiotics, bowel preparation and postoperative fasting may influence perioperative microbial population of intestinal tract to some extent, it is easy to cause disbalance of intestinal microecology, early postoperative feeding may improve this disbalance.