邵云娣 路娜娜 赵敏

[摘要] 目的 觀察益生菌对于结肠癌化疗患者肠道菌群及化疗相关并发症的影响。 方法 选择2015年5月～2016年11月收治的90例结肠癌术后需要化疗的患者（化疗方案均采用奥沙利铂联合亚叶酸钙、氟尿嘧啶），随机分为治疗组和对照组，每组45例。治疗组在开始化疗的同时开始服用双歧杆菌四联活菌片，每次3粒，每天3次；对照组在开始化疗时不给予双歧杆菌四联活菌片干预。观察两组化疗期间不良反应的发生率。收集两组患者的粪便，检测化疗前后双歧杆菌、乳酸杆菌、肠球菌、大肠杆菌、葡萄球菌的含量变化；检测两组化疗前后血中CD4+、CD8+T细胞的比例及CD4+/CD8+比值水平。 结果 在化疗期间，与对照组相比，治疗组患者的恶心、呕吐，腹泻，食欲下降的发生率明显下降（P<0.05）。化疗后，治疗组的双歧杆菌、乳酸杆菌高于对照组，而肠球菌、大肠杆菌、葡萄球菌的含量明显低于对照组（P<0.05）；化疗后，与对照组相比，治疗组CD4+T细胞的比例明显升高，CD8+T细胞比例下降，CD4+/CD8+比值水平明显高于对照组。 结论 益生菌有利于调整结肠癌化疗患者的肠道菌群，提高患者的免疫力，减少化疗相关并发症的发生。

[关键词] 益生菌；结肠癌；化疗；肠道菌群；免疫功能

[中图分类号] R735.34 [文献标识码] A [文章编号] 1673-9701（2018）02-0023-04

[Abstract] Objective To observe the effect of probiotics on intestinal flora and chemotherapy-related complications in patients with chemotherapy of colon cancer. Methods 90 patients with colon cancer needing postoperative chemotherapy who were treated in our hospital from May 2015 to November 2016 were enrolled in this study. All patients were treated with chemotherapy regimen of oxaliplatin combined with leucovorin calcium and fluorouracil. The patients were divided into treatment group and control group， with 45 cases in each group. The treatment group was given bifidobacterium tetravaccine tablets at the same time of starting chemotherapy， with 3 capsules each time for 3 times a day. The control group was not given bifidobacterium tetravaccine tablets at the beginning of chemotherapy. The incidence of adverse reactions in both groups was observed. The feces of both groups were collected. The content changes of bifidobacterium， lactobacillus， enterococcus， escherichia coli and staphylococcus were detected before and after chemotherapy. The ratios of CD4+， CD8+ T cells and CD4+/CD8+ between the two groups before and after chemotherapy were detected. Results During chemotherapy， the incidence of nausea， vomiting， diarrhea and loss of appetite decreased significantly in the treatment group compared with that of the control group（P<0.05）. After chemotherapy， the content of bifidobacterium and lactobacillus in the treatment group were higher than that of the control group， while the content of enterococcus， escherichia coli， staphylococcus aureus was significantly lower than that of the control group（P<0.05）. In the treatment group， the ratio of CD4+ T cells was significantly increased， the proportion of CD8+ T cells was decreased after chemotherapy， compared with that of the control group. The ratio of CD4+/CD8+ was significantly higher than that of the control group. Conclusion The probiotics are beneficial to adjust the intestinal flora of patients with chemotherapy of colon cancer， improve the immunity and to reduce the incidence of chemotherapy-related complications.

[Key words] Probiotics； Colon cancer； Chemotherapy； Intestinal flora； Immune function

結肠癌是最常见的癌症之一，在亚洲国家有逐年增加的趋势[1]。然而，由于手术方式及后续治疗措施（比如放疗、化疗）的发展，结肠癌的5年存活率有稳步上升[2]。化疗是结肠癌后期治疗的重要方法之一，其可导致患者出现肠道菌群失调，从而引起恶心、呕吐，腹泻，食欲下降等并发症，这些并发症严重影响了结肠癌患者的化疗期间的生活质量，甚至可能导致化疗终止[3]。益生菌是一种影响宿主中肠道微生物平衡的活微生物的食物补充剂，已知对人类健康具有许多有益效果[4]。本研究探讨益生菌对于改善结肠癌患者化疗期间肠道菌群及免疫力是否有影响，观察益生菌是否能减少结肠癌患者化疗期间的并发症的发生，现报道如下。……