中华临床营养杂志
中華臨床營養雜誌
중화림상영양잡지
CHINESE JOURNAL OF CLINICAL NUTRITION
2014年
2期
74-81
,共8页
陈红旗%夏阳%石忱长%梁勇%杨永志%秦环龙
陳紅旂%夏暘%石忱長%樑勇%楊永誌%秦環龍
진홍기%하양%석침장%량용%양영지%진배룡
益生菌制剂%结直肠癌%围手术期%肠屏障功能%肠道菌群
益生菌製劑%結直腸癌%圍手術期%腸屏障功能%腸道菌群
익생균제제%결직장암%위수술기%장병장공능%장도균군
Probiotics%Colorectal cancer%Perioperative period%Intestinal barrier%Intestinal flora
目的 探讨酪酸梭菌二联活菌对结直肠癌患者围手术期的影响及其作用机制.方法 我院2011年5月至7月共70例限期行结直肠癌手术患者,采用随机数字表法分为试验组(n=35)和对照组(n=35).两组于术前5d至术后7d每日分别给予酪酸梭菌二联活菌制剂和安慰剂,于术中采集结直肠组织标本,超微电镜下观察肠上皮紧密连接结构,采用Western blot和实时RT-PCR技术分析肠黏膜上皮细胞紧密连接蛋白的表达,采用Ussing Chamber技术评估肠上皮通透性.术后第7天收集患者粪便标本和血标本,采用末端限制性片段长度多态性(T-RFLP)技术分析粪便菌群多样性,并采用细菌培养方法对特定细菌进行定量检测.记录患者术后首次排气排便时间、腹泻腹胀发生率、全身炎症反应及术后感染并发症等临床参数.结果 与对照组比较,试验组的结直肠黏膜上皮紧密连接超微结构明显改善,Western blot和RT-PCR均证实试验组的紧密连接蛋白occludin、claudin-1和ZO-l的蛋白和mRNA表达水平显著提高(蛋白:P均＜0.001;mRNA:P=0.005、0.001、0.006),跨膜电阻增加[(28.3 ±5.2)Ω·cm2比(22.1±4.7)Ω·cm2,P=0.002],对大分子物质甘露醇的通透性降低[(0.91±0.17)％比(1.65±0.33)％,P＜0.001];肠道菌群的T-RFLP及细菌培养检测发现,试验组肠道菌群多样性增加(P =0.006),肠道双歧杆菌[(143.4±35.9)比(100.0±0.0),P=0.002]和乳酸杆菌[(111.3±52.9))比(100.0±0.0),P＜0.001]生长增加,产气荚膜梭菌生长减少[(66.2±23.7)比(100.0±0.0),P＜0.001].临床观察发现,试验组术后排气[(2.5±1.7)d比(4.5±2.0)d,P＜0.001]和排便时间[(5.0±1.3)d比(6.3±1.1)d,P=0.002]显著缩短,腹泻(20％比40％,P=0.005)和腹胀发生率降低(35％比60％,P=0.021).结论 酪酸梭菌二联活菌用于结直肠癌患者围手术期可有效增强肠黏膜上皮屏障功能,维护肠道菌群稳态,显著缩短结直肠癌患者术后首次排气、排便时间,降低腹泻和腹胀发生率,促进肠功能恢复.
目的 探討酪痠梭菌二聯活菌對結直腸癌患者圍手術期的影響及其作用機製.方法 我院2011年5月至7月共70例限期行結直腸癌手術患者,採用隨機數字錶法分為試驗組(n=35)和對照組(n=35).兩組于術前5d至術後7d每日分彆給予酪痠梭菌二聯活菌製劑和安慰劑,于術中採集結直腸組織標本,超微電鏡下觀察腸上皮緊密連接結構,採用Western blot和實時RT-PCR技術分析腸黏膜上皮細胞緊密連接蛋白的錶達,採用Ussing Chamber技術評估腸上皮通透性.術後第7天收集患者糞便標本和血標本,採用末耑限製性片段長度多態性(T-RFLP)技術分析糞便菌群多樣性,併採用細菌培養方法對特定細菌進行定量檢測.記錄患者術後首次排氣排便時間、腹瀉腹脹髮生率、全身炎癥反應及術後感染併髮癥等臨床參數.結果 與對照組比較,試驗組的結直腸黏膜上皮緊密連接超微結構明顯改善,Western blot和RT-PCR均證實試驗組的緊密連接蛋白occludin、claudin-1和ZO-l的蛋白和mRNA錶達水平顯著提高(蛋白:P均＜0.001;mRNA:P=0.005、0.001、0.006),跨膜電阻增加[(28.3 ±5.2)Ω·cm2比(22.1±4.7)Ω·cm2,P=0.002],對大分子物質甘露醇的通透性降低[(0.91±0.17)％比(1.65±0.33)％,P＜0.001];腸道菌群的T-RFLP及細菌培養檢測髮現,試驗組腸道菌群多樣性增加(P =0.006),腸道雙歧桿菌[(143.4±35.9)比(100.0±0.0),P=0.002]和乳痠桿菌[(111.3±52.9))比(100.0±0.0),P＜0.001]生長增加,產氣莢膜梭菌生長減少[(66.2±23.7)比(100.0±0.0),P＜0.001].臨床觀察髮現,試驗組術後排氣[(2.5±1.7)d比(4.5±2.0)d,P＜0.001]和排便時間[(5.0±1.3)d比(6.3±1.1)d,P=0.002]顯著縮短,腹瀉(20％比40％,P=0.005)和腹脹髮生率降低(35％比60％,P=0.021).結論 酪痠梭菌二聯活菌用于結直腸癌患者圍手術期可有效增彊腸黏膜上皮屏障功能,維護腸道菌群穩態,顯著縮短結直腸癌患者術後首次排氣、排便時間,降低腹瀉和腹脹髮生率,促進腸功能恢複.
목적 탐토락산사균이련활균대결직장암환자위수술기적영향급기작용궤제.방법 아원2011년5월지7월공70례한기행결직장암수술환자,채용수궤수자표법분위시험조(n=35)화대조조(n=35).량조우술전5d지술후7d매일분별급여락산사균이련활균제제화안위제,우술중채집결직장조직표본,초미전경하관찰장상피긴밀련접결구,채용Western blot화실시RT-PCR기술분석장점막상피세포긴밀련접단백적표체,채용Ussing Chamber기술평고장상피통투성.술후제7천수집환자분편표본화혈표본,채용말단한제성편단장도다태성(T-RFLP)기술분석분편균군다양성,병채용세균배양방법대특정세균진행정량검측.기록환자술후수차배기배편시간、복사복창발생솔、전신염증반응급술후감염병발증등림상삼수.결과 여대조조비교,시험조적결직장점막상피긴밀련접초미결구명현개선,Western blot화RT-PCR균증실시험조적긴밀련접단백occludin、claudin-1화ZO-l적단백화mRNA표체수평현저제고(단백:P균＜0.001;mRNA:P=0.005、0.001、0.006),과막전조증가[(28.3 ±5.2)Ω·cm2비(22.1±4.7)Ω·cm2,P=0.002],대대분자물질감로순적통투성강저[(0.91±0.17)％비(1.65±0.33)％,P＜0.001];장도균군적T-RFLP급세균배양검측발현,시험조장도균군다양성증가(P =0.006),장도쌍기간균[(143.4±35.9)비(100.0±0.0),P=0.002]화유산간균[(111.3±52.9))비(100.0±0.0),P＜0.001]생장증가,산기협막사균생장감소[(66.2±23.7)비(100.0±0.0),P＜0.001].림상관찰발현,시험조술후배기[(2.5±1.7)d비(4.5±2.0)d,P＜0.001]화배편시간[(5.0±1.3)d비(6.3±1.1)d,P=0.002]현저축단,복사(20％비40％,P=0.005)화복창발생솔강저(35％비60％,P=0.021).결론 락산사균이련활균용우결직장암환자위수술기가유효증강장점막상피병장공능,유호장도균군은태,현저축단결직장암환자술후수차배기、배편시간,강저복사화복창발생솔,촉진장공능회복.
Objective To evaluate the effects of perioperative probiotics administration on patients with colorectal cancer and to explore its possible mechanism.Methods Seventy patients with colorectal cancer who were scheduled to undergo radical colorectomy at Shanghai Sixth People's Hospital between May 2011 and July 2011 were randomly divided with random number table into the control group (n =35) and the treatment group (n =35).The two groups in 5 days preoperatively and 7 days postoperatively were given daily doses of probiotics preparation consisting of two combined live bacteria and placebo,respectively.The structure of intestinal epithelial tight junction was observed by electron microscopy in colorectal tissue specimens collected during the operation.The expression of tight junctional protein was detected using Western blot and real-time RT-PCR technology.Intestinal epithelial permeability was evaluated by Ussing Chamber system.Stool samples and blood samples were collected on the 7th day after operation.The diversity of faecal flora was analyzed by terminal restriction fragment length polymorphism (T-RFLP) technique,and the quantitative detection of specific bacteria was conducted by bacterial culture.Clinical parameters including the first exhaust and defecate time,distension and diarrhea incidence,systemic inflammatory response,and postoperative infective complications were recorded.Results Compared with the control group,the treatment group showed better intestinal epithelial tight junction ultrastructure.The expression of tight junction proteins occludin,claudin-1,and ZO-1 (protein:all P ＜ 0.001 ; mRNA:P =0.005,0.001,0.006) and the transepithelial electrical resistance [(28.3 ±5.2) Ω · cm2 vs.(22.1 ± 4.7) Ω · cm2,P =0.002] were significantly increased,the large molecule permeability [(0.91 ± 0.17) ％ vs.(1.65 ± 0.33) ％,P ＜ 0.001] reduced,the diversity of intestinal flora (P=0.006) increased,the growth of intestinal Bifidobacteria [(143.4 ±35.9) vs.(100.0 ±0.0),P=0.002] and Lactobacilli [(111.3 ± 52.9) vs.(100.0 ± 0.0),P ＜ 0.001] promoted,and the growth of Clostridium perfringens [(66.2 ±23.7) vs.(100.0 ±0.0),P ＜0.001] inhibited in the treatment group.The treatment group also showed shorter postoperative exhaust [(2.5 ± 1.7) d vs.(4.5 ±2.0) d,P ＜0.001] and defecate time [(5.0 ± 1.3) d vs.(6.3 ± 1.1) d,P =0.002],lower incidence of diarrhea (20％ vs.40％,P =0.005) and abdominal distension (35 ％ vs.60％,P =0.021).Conclusion Probiotics used perioperatively in patients with colorectal cancer can effectively enhance the intestinal epithelia barrier function,maintain the homeostasis of gut flora,shorten the postoperative first exhaust and defecate time,reduce the incidence of diarrhea and abdominal distension,and promote the recovery of intestinal function.
