结直肠癌围手术期替代应用肠道微生态制剂对肠道菌群及机体免疫功能的影响

Effect of perioperative intestinal probiotics on intestinal flora and immune function in patients with colorectal cancer

目的探讨结直肠癌患者围手术期应用肠道微生态制剂代替传统的术前口服肠道抗菌药对肠道菌群及机体免疫功能的影响。方法选取需施行腹腔镜结直肠癌根治术病例60例,随机分为对照组和实验组,30例/组。对照组术前肠道准备按传统方法(术前口服肠道抗菌药),实验组于术前5 d起口服肠道微生态制剂(金双歧片)2.0 g,3次/d,代替术前肠道抗菌药的使用,术后24 h起口服金双歧片2.0 g,3次/d,至术后第7天。于入院时、术后第7天收集两组新鲜大便以及空腹外周静脉血,比较两组肠道菌群比例,以及血清白介素-2(IL-2)、IgA、IgG和IgM浓度、NK细胞活性、T淋巴细胞亚群CD3+、CD4+、CD8+比例及CD4+/CD8+比值。结果肠道菌群:术后第7天实验组的双歧杆菌、乳酸杆菌、肠球菌菌群数量显著高于对照组(P<0.05),大肠杆菌、葡萄球菌数量显著低于对照组(P<0.05);体液免疫功能:术后第7天实验组IL-2、IgA、IgG、IgM水平均显著高于对照组(P<0.05);细胞免疫功能:术后第7天实验组CD4+水平显著高于对照组(P<0.05)。结论结直肠癌围手术期应用肠道微生态制剂代替传统的术前口服肠道抗菌药,不仅能有效地纠正肠道菌群失调,还具有改善术后患者免疫功能低下的作用。

Objective To investigate the effect of perioperative application of intestinal probiotics to substitute oral intestinal antimicrobial agents on intestinal flora and immune function in surgical patients with colorectal cancer. Methods Sixty patients with colorectal cancer undergoing elective laparoscopic radical surgery were randomized to receive preoperative bowel preparation using oral intestinal antimicrobial agents （n=20） or using oral intestinal probiotics （Jinshuangqi Tablets, 2.0 g, 3 times daily） since the fifth day before the operation and at 24 h after the operation for 7 consecutive days. Upon admission and 7 days after the operation, fecal samples and fasting peripheral venous blood were collected from the patients to examine the intestinal flora and serum levels of interleukin-2 （IL-2）, IgA, IgG, and IgM, NK cell activity, T lymphocytes subsets CD3＋, CD4＋, CD8＋ and CD4＋/CD8＋ ratio. Results At 7 days after the operation, the patients receiving probiotics showed significantly increased counts of intestinal Bifidobacterium, Lactobacillus, and Enterococcus （P〈0.05） and significantly lowered counts of Escherichia coli and Staphylococcus aureus （P〈0.05）. The serum levels of IL-2, IgA, IgG and IgM as well as CD4＋ cell percentage all increased significantly in probiotics group compared with those in patients with conventional intestinal preparation （P〈0.05）. Conclusion Perioperative application of intestinal probiotics to replace preoperative oral intestinal antimicrobial agents can effectively correct intestinal flora imbalance and improve the immune function of surgical patients with colorectal cancer.