结肠癌术后化疗感染与细胞免疫及肠道菌群的关系

Association between postoperative infection in colon cancer patients and cellular immunity and intestinal flora

目的 探讨结肠癌(CC)术后化疗感染患者细胞免疫指标变化与肠道菌群构成和多样性的关系。方法 回顾性分析2020年1月-2022年1月解放军联勤保障部队第903医院行CC根治术和化疗的107例CC患者的临床资料,根据化疗期间感染情况分为感染组23例和非感染组84例。分别于化疗前和化疗3个月后,无菌采集患者痰液、中段尿、粪便及皮肤创面分泌物行病原菌分离鉴定,收集患者化疗3个月后首次新鲜粪便行肠道菌群检测,应用流式细胞仪检测CD_(3)^(+)、CD_(4)^(+)和CD_(8)^(+)表达水平,计算CD_(4)^(+)/CD_(8)^(+)值。比较感染组和非感染组CC术后化疗患者一般资料和化疗前后细胞免疫功能指标水平、肠道菌群构成及多样性。结果 化疗后,感染组CD_(3)^(+)、CD_(4)^(+)水平和CD_(4)^(+)/CD_(8)^(+)值低于非感染组,CD_(8)^(+)高于非感染组(P<0.05);两组大肠埃希菌、肠球菌和肠道菌群丰富度、多样性指数高于化疗前,乳酸杆菌和双歧杆菌低于化疗前,感染组大肠埃希菌、肠球菌和肠道菌群丰富度、多样性指数均高于非感染组,乳酸杆菌和双歧杆菌均低于非感染组(P<0.05)。结论 CC术后化疗感染患者细胞免疫功能指标水平降低,肠道有益菌群丰度下降,致病菌丰度升高,肠道菌群多样性下降。

OBJECTIVE To explore the relationship between change of cellular immunity indexes and composition and diversity of intestinal flora in the colon cancer(CC)chemotherapy patients with postoperative infection.METHODS Totally 107 colon cancer patients who underwent radical surgery and received chemotherapy in the 903th Hospital of the PLA Joint Logistic Support Force from Jan 2020 to Jan 2022 were enrolled in the study and were divided into the infection group with 23 cases and the non-infection group with 84 cases according to the sta-tus of infection during the chemotherapy.The clinical data of the enrolled patients were retrospectively analyzed.The sputum,midstream urine,stool and skin wound secretion specimens were collected by aseptic approach be-fore the chemotherapy and after the chemotherapy for 3 months,the pathogens were isolated and identified.The fresh stool specimens were collected for the first time after the chemotherapy for 3 months,the intestinal flora were detected.The expression levels of CD_(3)^(+),CD_(4)^(+)and CD_(8)^(+)were detected by flow cytometry,the ratio of CD_(4)^(+)to CD_(8)^(+)was calculated.The clinical data,cellular immunity indexes,composition and diversity of intestinal flora were observed and compared between the infection group and the non-infection group before and after the chemotherapy.RESULTS The CD_(3)^(+)and CD_(4)^(+)levels and the ratio of CD_(4)^(+)to CD_(8)^(+)were lower in the infection group than in the non-infection group after the chemotherapy,while the CD_(8)^(+)level of the infection group was higher than that of the non-infection group(P<0.05).The abundance and diversity indexe of Escherichia coli,Enterococcus and intestinal flora of the two groups were higher after the chemotherapy than before the chemother-apy,the abundance and diversity indexe of Lactobacillus and Bifidobacterium of the two groups were lower after the chemotherapy than before the chemotherapy.The abundance and diversity index of E.coli,Enterococcus and intestinal flora of the infection group were higher than those of the non-infection group,while the abundance and diversity index of Lactobacillus and Bifidobacterium of the infection group were lower than those of the non-infec-tion group(P<0.05).CONCLUSION The CC chemotherapy patients with postoperative infection show the decline of cellular immunity indexes,reduction of abundance of beneficial intestinal flora,rise of abundance of pathogenic flora and the decline of diversity of intestinal flora.