益生菌对白血病化疗后继发腹泻患者的影响

Effect of probiotics on diarrhea secondary to chemotherapy for leukemia

目的研究益生菌辅助应用对急性淋巴细胞白血病化疗后继发腹泻患者肠黏膜屏障功能及炎性细胞因子水平的影响.方法选择2015-01/2016-12在台州市立医院治疗的化疗相关性腹泻患者90例.随机分为对照组(n=45)和观察组(n=45),对照组患者在常规对症支持治疗的基础上加用蒙脱石散,观察组患者在对照组的基础上加用双歧杆菌三联活菌胶囊.比较两组患者的临床疗效、肠黏膜屏障功能、炎性细胞因子水平及肠道菌群等.结果观察组患者显效25例(55.56%),有效17例(37.78%),总有效率为93.33%,对照组总有效率为75.56%(P<0.05).治疗前两组患者的肠黏膜屏障功能指标水平相近(P>0.05),治疗后两组患者的二胺氧化酶(d i a m i n e oxidase,DAO)、D-乳酸和内皮素(endothelin,ET)水平均明显下降,观察组患者的DAO、D-乳酸和ET水平低于对照组(P<0.05).治疗前两组患者的炎性细胞因子水平相近(P>0.05),治疗后两组患者的肿瘤坏死因子-?(tumor necrosis factor alpha,TNF-?)、降钙素原(procalcitonin,PCT)和白介素(interleukin,IL)-6水平均明显下降,观察组患者的TNF-?、PCT和IL-6水平低于对照组(P<0.05).对照组治疗后的肠道菌群数值较治疗前明显降低,观察组治疗后双歧杆菌、乳杆菌较治疗前明显增多,观察组治疗后肠道菌群数值明显高于对照组(P<0.05),观察组肠杆菌、肠球菌、大肠埃希菌数值治疗前后相近(P>0.05).结论双歧杆菌辅助应用可以明显提高急性淋巴细胞白血病患者化疗相关性腹泻的临床疗效,降低炎性细胞因子水平,改善肠黏膜屏障功能,调节肠道菌群平衡紊乱,重建肠道生态平衡,值得在临床推广.

AIM To evaluate the effect of probiotics on intestinal mucosalbarrier function and inflammatory cytokine levels in patients with diarrhea secondary to chemotherapy for acute lymphoblastic leukemia.METHODS Ninety patients with chemotherapy-associated diarrhea treated at Taizhou Municipal Hospital from January 2015 to December 2016 were randomly divided into a control group（n = 45） and an observation group（n = 45）. Both groups were given montmorillonite powder-based conventional symptomatic treatment, and the observation group was additionally given Bifidobacterium triple viable capsules. Clinical efficacy, intestinal mucosal barrier function, inflammatory cytokine levels, and intestinal fl ora were compared between the two groups.RESULTS In the observation group, 25（55.56%） cases showed marked improvement and 17（37.78%） cases showed improvement, with a total effective rate of 93.33%, which was significantly higher than that in the control group（75.56%; P〈0.05）. Before treatment, intestinal mucosal barrier function indexes were similar between the two groups（P〈0.05）; after treatment, diamine oxidase, D-lactic acid, and endothelin were significantly decreased in both groups, and the decrease was significantly more remarkable in the observation group（P〈0.05）. Before treatment, inflammatory cytokines in the two groups were similar（P〈0.05）; after treatment, tumor necrosis factor-？, procalcitonin, and interleukin-6 were significantly decreased in both groups, and the decrease was significantly more remarkable in the observation group（P〈0.05）. The number of intestinal microbes after treatment was significantly lower than that before treatment in the control group. In the observation group, Bifidobacterium and Lactobacillus were significantly increased after treatment, and the number of intestinal microbes was significantly higher than that of the control group（P〈0.05）. Enterobacteriaceae, Enterococcus, andEscherichia coli showed no significant changes between before and after treatment in the observation group（P〈0.05）.CONCLUSION Auxiliary application of probiotics can significantly improve the therapeutic efficacy for chemotherapyinduced diarrhea in acute lymphoblastic leukemia patients, reduce the levels of inflammatory cytokines,improve intestinal mucosal barrier function, regulate the balance of intestinal fl ora disturbance, and reconstruct intestinal ecological balance.