恶性血液病患者化疗前后肠道免疫功能及微生态改变状况研究

Changes of intestinal microflora and immune function after chemotherapy maybe associated with fever in patients with neutropenia

目的探讨恶性血液病患者化疗后肠道免疫功能及微生态改变状况。方法采用前瞻性队列研究。入选初发恶性血液病并需要化疗的患者,留取化疗前后粪便标本。根据患者化疗后是否出现发热,分为粒细胞减少伴发热组及粒细胞减少不伴发热组。采用光冈法对粪便需氧菌及厌氧菌进行定量培养,分析肠道菌群变化。同时检测患者化疗前后粪便IgA值变化。结果共纳入24例患者,化疗后出现粒细胞减少症伴发热的患者10例,占41.7%;未发热患者14例,占58.3%。24例患者化疗后粪便IgA水平及B/E值显著性下降,肠道微生态发生改变,具体表现为肠杆菌、假单胞菌及真菌显著增多。化疗后,粒细胞减少伴发热组与未发热组相比肠杆菌及真菌显著增多,两组患者粪便IgA水平、B/E值变化无明显差异。结论恶性血液病患者化疗后肠道免疫功能、微生物定植抗力下降,侵袭性细菌增多。化疗后粒细胞减少伴发热患者肠杆菌显著增多,可能成为粒细胞减少症伴发热患者的潜在致病菌。

Objective To evaluate the changes of intestinal microflora and immune function of gut in hematological patients after chemotherapy. Methods Patients with primary hematological malignancies in the department of hematology or oncology were included in the study.Fecal samples were collected before and after chemotherapy. Depending on the body temperature, the patients were divided into neutropenia with fever group or neutropenia without fever group.The level of immunoglobulin A and intestinal microflora in feces were examined to investigate the impacts of chemotherapy. Results Among the 24 patients included in this study, fever occurred in 10 （41.7%） patients after chemotherapy. After chemotherapy, the levels of immunoglobulin A in the feces and B/E values of all the patients decreased significantly, while the amounts of Enterobacteria, Pseudomonas and fungi in the gut increased significantly after chemotherapy. Compared with the patients without fever, those in the febrile neutropenia group had more increments in the number of Enterobacteria and Fungi. The two groups had no significance differences in the level of immunoglobulin A in the feces and B/E value.ConclusionWorse immune function,colonization resistance and more invasive bacteria were found after chemotherapy in hematological patients, among which Enterobacteria may be the potential pathogenic bacteria in febrile neutropenia patients.