摘要
目的研究益生菌对大肠癌术后患者肠屏障功能及炎症反应的影响。方法60例择期大肠癌手术患者分为益生菌组和对照组,每组各30例。分别于术后第3～7d给予等氮量、等热卡营养支持。从术后第1d起,益生菌组口服优菌多2g/d,共7d。于术后每天观察2组患者体温及心率情况;术前,术后第1、5、8d分别进行白细胞计数;术前,术后第1、8d检测全血细菌DNA、血浆D-乳酸水平及尿乳果糖/甘露醇(L/M)比值;观察2组患者全身炎症反应综合征(SIRS)和感染并发症发生情况。结果益生菌组术后发热持续时间、术后5d平均心率及白细胞计数恢复正常时间均明显短于或低于对照组(P<0.01)。术后第1d2组患者外周血细菌DNA检测阳性率差异无统计学意义;第8d对照组仍有7例(23.3%)PCR检测呈阳性,而益生菌组为1例(3.3%),2组间差异有统计学意义(P<0.05)。对照组血浆D-乳酸水平由术后第1d的(6.63±1.29)ng/ml下降至第8d的(0.95±0.83)ng/ml,而益生菌组则由(6.90±1.41)ng/ml下降至(0.56±0.18)ng/ml,第8d时2组间差异有统计学意义(P<0.05)。对照组L/M比值由术后第1d的0.053±0.019升高至第8d的0.063±0.016,益生菌组则由0.047±0.012降至0.031±0.008,第8d时2组间差异有统计学意义(P<0.01)。术后SIRS发生率及感染并发症的发生率2组间差异无统计学意义(P>0.05)。结论益生菌能降低大肠癌患者术后肠道通透性,减少细菌易位,有利于大肠癌患者术后早期炎症反应的恢复。
Objective To study the effect of probiotics on the change of intestinal permeability and inflammatory reaction after surgery of colorectal cancer. Methods Sixty patients who underwent colonic surgery were randomly divided into two groups： probiotic group and control group, with 30 cases in each group. Each group received nutritional support of the same nitrogen and calorie from day 3 to day 7 after operation. The patients in probiotic group were orally administrated probiotic （2 g/d） from the first day after surgery for 7 days. Every patient＇s body temperature and heart rate were observed after operation, and white blood cell counts were observed before operation and on day 1, 5, 8 after operation. The levels of microbial DNA in whole blood and plasma D-lactate, and urine lactulose/mannito （L/M） ratio were measured before operation and on day 1 and day 8 after operation, respectively. In addition, the occurrence of postoperative systemic inflammatory response syndrome （SIRS） and complications of inflammation were closely observed. Results The average heart rate in postoperative 5 days was significantly lower in probiotics group than that in control group （P〈0.01）. The duration of fever and the recovery time for white blood cell counts decreasing to normal were significantly less in probiotics group than those in control group （P〈 0.01） as well. There was no significant difference of positive rate of microbial DNA in peripheral blood on day 1 after operation between two groups. However, the number of patients that showed positive result of microbial DNA PCR test in probiotic group （1 case, 3.3 % ） was significantly less than that of control group （7 cases, 23.3 % ）on day 8 after operation （P〈0.05）. The level of plasma D-lactate in probiotic group （decreasing from （6.90± 1.41） ng/ml on day 1 to （0.56±0.18） ng/ml on day 8） was also significantly lower than that in control group （decreasing from （6. 63±1. 29） ng/mlonday 1 to （0.95±0.83） ng/mlon day 8] on day 8 after operation （P〈0.05）. Urine L/M ratio increased from 0. 053±0. 019 on day 1 to 0. 063±0. 016 on day 8 after operation in control group; while in probiotic group, the ratio decreased from 0. 047±0. 012 on day 1 to 0. 031±0. 008 on day 8 after operation, and there was significantly statistical difference of the ratio between two groups on day 8 （P〈0.01）. There was no significant difference of the occurrence rate of SIRS and complications of inflammation between two groups （P〉 0.05）. Conclusion Probiotics can decrease intestinal permeability and maintain the intestinal barrier function after operation. It may be helpful for the recovery of patients with early inflammatory response after surgery of colorectal cancer.
出处
《中国普外基础与临床杂志》
CAS
2008年第11期805-810,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
益生菌
肠道通透性
肠屏障功能
结直肠肿瘤
Probiotics Intestinal permeability Intestinal barrier function Colorectal cancer
作者简介
夏阳（1973年-），男，上海市人，同济大学医学院在读硕士研究生，主治医师，研究方向：胃肠外科，E—mail：xia．yangs@gmail．com。
[通讯作者]秦环龙，Email：hlqin@situ．edu．cn
