乳腺癌病人化疗期间口服益生菌制剂对肠道菌群和认知功能障碍的影响

Effects of oral probiotics during chemotherapy on gut microbiota and cognitive dysfunction in breast cancer patients

目的:探讨口服益生菌制剂对乳腺癌化疗病人肠道菌群及认知功能障碍的影响。方法:纳入2021年12月至2022年6月安徽省蚌埠医科大学第一附属医院肿瘤外科女性乳腺癌术后接受蒽环类化疗的病人30例,采用随机数字表法将病人随机分为观察组和对照组,每组15例。两组化疗期间均口服肠内营养制剂,观察组于化疗期间口服益生菌制剂。分析对比两组化疗前后粪便菌群差异,以及病人主、客观认知功能水平变化、化疗相关胃肠道不良反应和营养状况。结果:两组病人化疗前后肠道菌群多样性指数Chao指数、Ace指数,Shannon指数、Simpson指数差异均无统计学意义(均P>0.05)。相对于对照组,观察组病人化疗后肠道Actinomyces菌丰度显著升高(P<0.05),而Acetoanaerobium、Lachnospiracea_incertae_sedis、unclassified_Frankineae菌丰度显著降低(P<0.05)。两组病人化疗后客观认知功能障碍和主观认知功能障碍的总分及各维度得分均较化疗前显著下降(P<0.05),但观察组化疗后评分显著高于对照组(P<0.05)。化疗期间,观察组胃肠道不良反应(便秘、恶心呕吐、腹泻、腹胀)发生率均显著低于对照组(P<0.05)。结论:口服益生菌制剂可以改善乳腺癌术后化疗病人的胃肠道不良反应和认知功能障碍,可能和调节肠道菌群紊乱有关。

Objective:To investigate the effects of oral probiotics on intestinal microbiota and cognitive dysfunction in breast cancer chemotherapy patients.Methods:Thirty breast cancer patients who received anthracycline chemotherapy between December 2021 and June 2022 in the Department of Oncology,the First Affiliated Hospital of Bengbu Medical University were included in this study.The patients were randomly divided into the observation and control groups(15 cases per group).During chemotherapy,the observation group was additionally given oral probiotics.The fecal microbiota compositions before and after chemotherapy were detected using 16S rDNA sequencing.The changes in patients' subjective and objective cognitive function levels were evaluated by Montreal Cognitive Assessment(MoCA) and Functional Assessment of Cancer Therapy-Cognitive(FACT-Cog),respectively.Results:The microbiota diversity,as indicated by the Chao,Ace,Shannon and Simpson indices,showed no significant difference between two groups(P > 0.05).As compared with the control group,the relative abundance of the genus Actinomyces in the feces was significantly higher than in the observation group(P < 0.05).By contrast,the relative abundance of the genera Acetoanaerobium,Lachnospiracea_incertae_sedis,and unclassified_Frankineae bacteria was significantly lower in the observation group(P < 0.05).The total scores of the objective and subjective cognitive function as well as the scores of each dimension in both groups were markedly decreased after chemotherapy(P < 0.05).The scores in the observation group were higher than those in the control group after chemotherapy(P < 0.05).During chemotherapy,the presence of the gastrointestinal adverse reactions(constipation,nausea and vomiting,diarrhea and abdominal distension) in the observation group were significantly lower than in control group(P < 0.05).Conclusion:Oral probiotics could improve the cognitive impairment and reduce the presence of the gastrointestinal side effects in the breast cancer patients receiving chemotherapy,which may be caused by modulating the intestinal microbiota.