肠内营养对结直肠癌患者脱落肿瘤细胞、菌群及免疫的影响

Effects of enteral nutrition on cancer cell shedding,flora and immunity in patients with colorectal cancer

目的探讨肠内营养对结直肠癌患者腹腔及肠腔内脱落肿瘤细胞、肠道菌群、免疫功能的影响。方法选取2022年3月至2023年3月于大连大学附属新华医院行根治术治疗的300例结直肠癌患者作为研究对象,按照随机数字表法分为试验组(肠内营养)与对照组(予以传统肠道准备),各150例。对比腹腔和肠腔内脱落细胞阳性率、肠道耐受性、肠道清洁度;观察术前和术后7 d的肠道菌群(双歧杆菌、乳酸杆菌、大肠埃希菌、肠球菌)、总蛋白(TP)、前清蛋白(PA)、白蛋白(ALB)、CD4~+T细胞百分比、CD8~+T细胞百分比,并计算CD4~+T细胞/CD8~+T细胞比值。结果试验组的腹腔、肠腔内脱落细胞阳性率分别为4.67%、10.67%,显著均低于对照组(P<0.05)。两组整体肠道耐受性(Ⅰ级/Ⅱ级/Ⅲ级)和肠道清洁度(Ⅰ级/Ⅱ级/Ⅲ级/Ⅳ级)比较,差异具有统计学意义(P<0.05)。两组术后7 d每克粪便湿重中双歧杆菌、乳酸杆菌的对数值高于术前,而大肠埃希菌、肠球菌的对数值低于术前(P<0.05)。试验组术后7 d的CD4~+T细胞百分比、CD8~+T细胞百分比、CD4~+T细胞/CD8~+T细胞比值,TP、PA、ALB水平高于术前(P<0.05);试验组术后7 d每克粪便湿重中双歧杆菌、乳酸杆菌、大肠埃希菌、肠球菌的对数值,CD4~+T细胞百分比、CD8~+T细胞百分比,CD4~+T细胞/CD8~+T细胞比值,TP、PA、ALB水平分别为(7.65±0.68)log GFU/g、(6.92±0.71)log GFU/g、(8.56±1.45)log GFU/g、(8.28±0.97)log GFU/g,(41.03±2.21)%、(26.25±2.07)%、(1.92±0.28),(69.52±6.82)g/L、(266.36±9.58)mg/L、(40.01±3.69)g/L,对照组分别为(6.19±0.42)log GFU/g、(6.08±0.43)log GFU/g、(9.31±1.72)log GFU/g、(9.01±1.21)log GFU/g,(30.14±1.48)%、(18.01±1.51)%、(1.50±0.19),(62.01±4.05)g/L、(217.08±8.41)mg/L、(31.82±3.12)g/L,两组比较,试验组每克粪便湿重中双歧杆菌、乳酸杆菌的对数值,CD4~+T细胞百分比、CD8~+T细胞百分比、CD4~+T细胞/CD8~+T细胞,TP、PA、ALB水平更高,大肠埃希菌、肠球菌的对数值更低,差异具有统计学意义(P<0.05)。结论结直肠癌患者术前予以肠内营养有利于减少腹腔及肠腔内脱落肿瘤细胞的阳性率和纠正胃肠道菌群,改善营养状态和免疫功能,对指导临床治疗和改善预后具有重要意义。

Objective To investigate the effects of enteral nutrition on cancer cell shedding,intestinal flora and immune function in patients with colorectal cancer.Method A total of 300 patients with colorectal cancer who underwent radical surgery in Xinhua Hospital Affiliated to Dalian University from March 2022 to March 2023 were selected as the study objects,and were divided into experimental group(given enteral nutrition)and control group(given traditional intestinal preparation)according to random number table method,with 150 cases each.The positive rate of exfoliated cells in abdominal cavity and intestinal cavity,intestinal tolerance and intestinal cleanliness were compared.The intestinal flora(bifidobacterium,lactobacillus,Escherichia coli,enterococcus),total protein(TP),prealbumin(PA),albumin(ALB),CD4~+,CD8~+were observed before and 7 days after surgery,and the CD4~+/CD8~+ratio was calculated.Result The positive rates of exfoliated cells in abdominal cavity and intestinal cavity of experimental group were 4.67%and 10.67%,respectively,which were significantly lower than those in control group(P<0.05).The overall intestinal tolerance(GradeⅠ/Ⅱ/Ⅲ)and intestinal cleanliness(GradeⅠ/Ⅱ/Ⅲ/Ⅳ)between the two groups were statistically significant(P<0.05).The quantity of bifidobacterium and lactobacillus was higher than that before operation,but the quantity of Escherichia coli and enterococcus was lower than that before operation(P<0.05).The levels of CD4~+,CD8~+,CD4~+/CD8~+,TP,PA and ALB in experimental group were higher than those before surgery(P<0.05).The levels of bifidobacterium,lactobacillus,Escherichia coli,Enterococcus,CD4~+,CD8~+,CD4~+/CD8~+,TP,PA and ALB were(7.65±0.68)log GFU/g,(8.56±1.45)log GFU/g,and(8.28±0.97)log GFU/g,(41.03±2.21)%,(26.25±2.07)%,(1.92±0.28),(69.52±6.82)g/L,(266.36±9.58)mg/L,(40.01±3.69)g/L,The control group was(6.19±0.42)log GFU/g,(6.08±0.43)log GFU/g,(9.31±1.72)log GFU/g,(9.01±1.21)log GFU/g,(30.14±1.48)%,(18.01±1.51)%,(1.50±0.19),(62.01±4.05)g/L,(217.08±8.41)mg/L,(31.82±3.12)g/L,compared between the two groups,Bifidobacterium,lactobacillus,CD4~+,CD8~+,CD4~+/CD8~+,TP,PA,ALB were higher in experimental groups,and Escherichia coli and Enterococcus were lower,the difference was statistically significant(P<0.05).Conclusion Preoperative enteral nutrition in patients with colorectal cancer is beneficial to reduce the positive rate of cancer cells shed in abdominal cavity and intestinal cavity,correct gastrointestinal flora,improve nutritional status and immune function,and is of great significance for guiding clinical treatment and improving prognosis.