肠道菌群特征对结肠癌化学治疗疗效的影响

Effect of intestinal flora characteristics on the therapeutic effect of different chemotherapy regimens for colorectal cancer

目的探讨肠道菌群特征对晚期结肠癌患者不同化学治疗(化疗)方案治疗效果的影响。方法采用前瞻性病例对照分析,选取2019年6月至2020年11月黄石市第二医院收治248例Ⅳ期结肠癌患者,其中采用卡培他滨+奥沙利铂(XELOX)化疗方案治疗者130例,随机分为XELOX联合组(XELOX+双歧杆菌乳杆菌三联活菌片)、XELOX组两组;采用奥沙利铂+亚酸钙+5-氟尿嘧啶(FOLFOX)化疗方案治疗者118例,随机分为FOLFOX联合组(FOLFOX+双歧杆菌乳杆菌三联活菌片)、FOLFOX组。检测各组治疗前后粪便标本中肠道菌群,并比较各组临床治疗效果。结果XELOX联合组较XELOX组治疗后双歧杆菌、乳酸杆菌、类杆菌较治疗前明显增多,肠杆菌、肠球菌、梭杆菌较治疗前明显减少(P<0.05);FOLFOX联合组较FOLFOX组治疗后双歧杆菌、乳酸杆菌、类杆菌较治疗前明显增多,肠杆菌、肠球菌、梭杆菌较治疗前明显减少(P<0.05)。XELOX联合组总有效率明显优于XELOX组(56.92%比43.08%,P<0.05),随访12个月期间死亡率明显低于XELOX组(21.54%比49.23%,P<0.05);FOLFOX联合组总有效率明显优于FOLFOX组(52.54%比44.07%,P<0.05),随访12个月期间死亡率明显低于FOLFOX组(22.03%比57.63%,P<0.05)。结论晚期结肠癌存在明显的肠道菌群失调情况,接受不同化疗方案治疗的晚期结肠癌患者同时予以调节肠道菌群的药物干预,可提高治疗效果,改善患者的生存情况。

Objective To explore the influence of intestinal flora characteristics on the therapeutic effect of different chemotherapy regimens for colorectal cancer.Methods A prospective case-control analysis was conducted to select 248 patients with stageⅣcolon cancer admitted to the Second Hospital of Huangshi City from June 2019 to November 2020.Among them,130 patients treated with capecitabine+oxaliplatin(XELOX)chemotherapy regimen were randomly divided into two groups:XELOX combination group(XELOX+bifidobacterium lactobacillus triple live bacterial tablets)and XELOX group;118 patients treated with oxaliplatin+calcium nitrite+5-fluorouracil(FOLFOX)chemotherapy regimen were randomly divided into two groups:the FOLFOX combination group(FOLFOX+bifidobacterium lactobacillus triple live bacterial tablets)and the FOLFOX group.The gut microbiota in fecal samples before and after treatment in each group were detected,and the clinical treatment effects of each group were compared.Results Compared with the XELOX group,bifidobacteria,lactobacilli and bacteroides in the XELOX combination group increased significantly after treatment,while enterobacteria,enterococcus and fusobacterium decreased significantly(P<0.05);Compared with the FOLFOX group,bifidobacteria,lactobacilli and bacteroides in the FOLFOX combination group were significantly increased after treatment,while enterobacteria,enterococcus and fusobacterium were significantly reduced after treatment(P<0.05).The total effective rate of the XELOX combination group was significantly higher than that of the XELOX group(56.92%vs.43.08%,P<0.05),and the mortality rate during the 12 month follow-up period was significantly lower than that of the XELOX group(21.54%vs.49.23%,P<0.05);The total effective rate of the FOLFOX combination group was significantly better than that of the FOLFOX group(52.54%vs.44.07%,P<0.05),and the mortality rate during the 12 month follow-up period was significantly lower than that of the FOLFOX group(22.03%vs.57.63%,P<0.05).Conclusion There is a significant imbalance of intestinal flora in patients with advanced colon cancer.Drug intervention to regulate intestinal flora can improve the treatment effect and improve the survival of patients.