双歧杆菌对化疗后肠道菌群紊乱及相关性肠炎的防治

发布时间：2018-02-25 06:00

  本文关键词： 恶性肿瘤化疗 肠道菌群 粪便菌群培养　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:癌症的治疗主要以手术、放化疗、靶向药物、生物免疫疗法及中医中药等方法为主,其中化疗作为抗癌治疗的一项重要手段,一些肿瘤会得到不同程度的控制,延长病人生命,然而,化疗后出现的血液学毒性,胃肠道毒性,器官毒性损害,脱发,静脉炎以及与化疗相关的疲劳性等副反应,限制了化疗药物的使用,其中有研究表明化疗后出现的一部分的胃肠道毒性与肠道菌群紊乱有关。因此对接受化疗的恶性肿瘤患者肠道菌群的定量分析,有助于从微生态角度了解化疗药物对肠道菌群的影响程度,并为微生态调节剂用于预防、减轻及治疗化疗引起的肠道菌群紊乱、化疗相关性肠炎及化疗相关性腹泻(CID)等副作用提供依据。本研究选取双歧杆菌、大肠杆菌、梭杆菌三种具有代表性菌种,留取接受化疗的恶性肿瘤患者粪便,随机分成两组,一组单纯化疗的对照组,另一组化疗过程中给予双歧杆菌菌调药物的实验组,通过粪便培养对在化疗前后肠道中上述菌群的变化定量分析,以了解化疗患者肠道内双歧杆菌、大肠杆菌、梭杆菌的菌量变化,对照组与实验组比较,了解双歧杆菌、大肠杆菌、梭杆菌的菌量是否有变化,探讨化疗药物是否对肠道微生态造成破环,最终达到可否用微生态调节剂预防或减轻患者化疗过程中各种肠源性副反应的目的,从而保证化疗的顺利进行,提高治疗水平,延长患者生命。方法:1.分组:选择2015年01月-2016年10月解放军第210医院肿瘤科收治的115例Ⅳ期恶性肿瘤化疗患者,其中肺癌38例、胃癌16例、乳腺癌30例、食管癌5例、胰腺癌7例及大肠癌19例,化疗方案为IP、DP、DCF、XT、TXT、FOLFOX、FOLFIRI、XELOX方案,随机分为两组,56例作为实验组,59例对照组。实验组口服双歧三联活菌肠溶胶囊,以上选择对象入组前2周内均无抗生素应用史及除肿瘤外的其他胃肠疾病史,实验组及对照组不少于四周期化疗。2.标本:实验组及对照组取入组后第一周期化疗前、第四周期化疗前、第四周期化疗第7天和14天粪便标本,通过培养基改良和培养鉴定方法对留取的粪便进行肠道菌群定量分析。结果:通过检测四周期化疗过程中患者粪便标本中双歧杆菌、大肠杆菌、梭杆菌三种菌群的数量,我们发现对照组化疗三周期后肠道内双歧杆菌及大肠杆菌明显减少,梭杆菌数量增加;使用微生态制剂的实验组患者肠道菌群无明显变化,临床观察发现实验组腹泻、腹痛、便秘等消化道反应明显减轻,差异有统计学意义。结论:1.化疗药物抑制肠道正常菌群生长,加重肠道菌群失调。2.化疗期间给予益生菌制剂,有助于增强体内肠道菌群平衡,减轻肠道菌群失调程度,减轻消化道反应及肠道黏膜炎症。
[Abstract]:Objective: the treatment of cancer mainly consists of surgery, radiotherapy and chemotherapy, targeted drugs, biological immunotherapy and traditional Chinese medicine, among which chemotherapy is an important means of anticancer treatment, and some tumors will be controlled to varying degrees. However, side effects such as hematological toxicity, gastrointestinal toxicity, organ toxicity, alopecia, phlebitis and chemotherapy-related fatigue after chemotherapy limit the use of chemotherapy drugs. Some studies have shown that some of the gastrointestinal toxicity after chemotherapy is related to intestinal microflora disorder. It is helpful to understand the influence of chemotherapeutic drugs on intestinal flora from the microecological point of view, and to be used as a microecological regulator to prevent, mitigate and treat intestinal microflora disorders caused by chemotherapy. In this study, bifidobacterium, Escherichia coli and Clostridium spp. Three representative bacteria were collected from the feces of malignant tumor patients who received chemotherapy, and were randomly divided into two groups. One group was treated with chemotherapy alone, the other group was treated with bifidobacterium in the course of chemotherapy. The bifidobacterium in the intestinal tract was quantitatively analyzed by fecal culture before and after chemotherapy, in order to understand the bifidobacterium in the intestinal tract of the patients with chemotherapy. The bacteria quantity of Escherichia coli and Clostridium spp. The control group was compared with the experimental group to find out if there were any changes in the bacteria quantity of Bifidobacterium, Escherichia coli and Clostridium, and to explore whether the chemotherapeutic drugs had broken down the intestinal microecology. Finally, it is possible to use microecological regulators to prevent or alleviate various enterogenic side effects in the course of chemotherapy in patients, so as to ensure the smooth progress of chemotherapy and improve the treatment level. From January 2015 to October 2016, 115 patients with stage 鈪，

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