胆管癌化疗患者小肠细菌过度生长情况

Overgrowth of bacteria in small intestine of patients with cholangiocarcinoma undergoing chemotherapy

目的探讨胆管癌化疗患者化疗前后小肠细菌过度生长(SIBO)情况及应用酪酸梭菌治疗SIBO后能否改善肿瘤患者的临床症状。方法选择62例于我院接受化疗的胆管癌患者作为观察组,选择同时段内于我院体检的健康志愿者50例作为对照组。观察组患者化疗前后及对照组均接受葡萄糖氢呼气试验(GHBT)检测SIBO阳性率。将观察组化疗后SIBO阳性患者分为益生菌治疗组和安慰剂组,比较其治疗前后SIBO阳性率及临床症状评分的变化。结果观察组患者化疗前SIBO阳性率为45.16%(28/62),化疗后SIBO阳性率为67.74%(42/62)。对照组SIBO阳性率为16.00%(8/50)。观察组患者化疗前后SIBO阳性率显著高于对照组,差异均有统计学意(均P<0.05)。观察组患者化疗后SIBO阳性率高于化疗前,差异有统计学意义(χ^2=6.43,P<0.05)。益生菌治疗组患者经酪酸梭菌治疗后SIBO转阴率为52.38%(11/21),安慰剂组为14.29%(3/21),且两组患者给药后的临床症状积分对比差异有统计学意义(均P<0.05)。结论胆管癌患者SIBO阳性率更高,化疗可进一步加重SIBO的发生。酪酸梭菌治疗胆管癌患者化疗后SIBO效果较好,可提高SIBO转阴率,改善胆管癌患者化疗后腹痛、腹胀等不适症状。

Objective To discuss the small intestinal bacterial overgrowth(SIBO)before and after chemotherapy in patients with cholangiocarcinoma and study whether the clinical symptoms of patients can be improved by using Clostridium butyricum.Methods Sixty-two patients with cholangiocarcinoma who received chemotherapy in our hospital were selected as the observation group.With healthy volunteers as controls.Glucose hydrogen breath test(GHBT)was conducted in both the observation group(before and after chemotherapy)and control group to detect SIBO status.The patients in observation group tested as SIBO positive were further divided into probiotics group or placebo group to compare the incidence of SIBO and clinical symptom scores before and after treatment between the two groups.Results In the observation group,the positive rate of SIBO 45.16%(28/62)before chemotherapy vs 67.74%(42/62)after chemotherapy,In contrast,the positive rate of SIBO in the 50 healthy controls was 16.00%(8/50).The positive rates of SIBO in the observation group before and after chemotherapy were significantly higher than those in the control group,respectively(all P<0.05).The positive rate of SIBO after chemotherapy in the observation group was higher than that before chemotherapy,with statistically significant difference(χ^2=6.43,P<0.05).52.38%of patients in probiotics group vs 14.29%in placebo group turned to SIBO negative after treatment,and there was significant difference in the clinical symptom scores after treatment between the two groups(all P<0.05).Conclusion Patients with cholangiocarcinoma has a higher incidence of SIBO compared with healthy population.SIBO can be further aggravated after chemotherapy.Clostridium butyricum is effective in the treatment of SIBO after chemotherapy in patients with cholangiocarcinoma,which can significantly improve the turnover rate of SIBO positive to negative and relieve the abdominal pain,abdominal distension and other symptoms of the patients.