恶性血液病患者化疗后并发感染与机体免疫功能及肠道微生态的关系

发布时间：2018-07-22 21:13

【摘要】：目的分析恶性血液病患者化疗前后机体免疫功能和肠道菌群的变化,探讨机体免疫功能及肠道微生态与化疗后并发感染的相关性。方法选择2012年1月-2015年12月无锡市第二人民医院收治的120例首发恶性血液病且需要化疗的患者,根据化疗后是否发生感染分为感染组(44例)和无感染组(76例)。于化疗前后留取患者血样和粪便标本,检测血液相关免疫细胞水平及粪便标本中分泌性免疫球蛋白A(sIgA)水平;分析肠道菌群变化,以双歧杆菌与肠杆菌的数量比值(B/E值)评价肠道定植抗力(CR)。结果化疗后,感染组患者外周血白细胞[(2.26±0.55)109/L]、中性粒细胞[(0.61±0.04)109/L]、CD3+[(25.51±3.23)%]、CD4+[(13.62±4.53)%]、CD4+/CD8+[(0.59±0.22)%]及sIgA水平[(0.58±0.07)g/L]均显著低于化疗前(t分别为-33.737、-55.831、-15.019、-11.182、-13.007、-28.387,P均0.05)和化疗后无感染组(t分别为-14.947、-74.774、-10.845、-4.661、-5.447、-21.696,P均0.05);与化疗前比,化疗后感染组患者粪便标本肠杆菌[(9.97±1.01)lg CFU/g]、肠球菌[(9.88±0.55)lg CFU/g]、不动杆菌[(7.84±0.70)lg CFU/g]、假单胞细菌[(5.11±0.89)lg CFU/g]及真菌[(9.54±0.87)lg CFU/g]菌落数显著增多(t分别为8.205、4.876、6.791、7.028、6.588,P均0.05),双歧杆菌[(5.24±0.37)lg CFU/g]和乳酸杆菌[(2.37±0.36)lg CFU/g]菌落数显著减少(t分别为-13.358、-48.641,P均0.05);且感染组较无感染组肠球菌、不动杆菌及真菌菌落数增加及双歧杆菌和乳酸杆菌菌落数减少更显著(t分别为3.717、6.510、5.384、-5.103、-11.028,P均0.05);感染组化疗后B/E值(0.53±0.07)显著小于化疗前(t=-12.903,P0.05)和无感染组化疗后(t=-6.131,P0.05)。结论恶性血液病患者化疗后机体免疫功能下降,肠道菌群紊乱,CR下降,造成免疫稳态失衡,患者发生感染的风险增加。
[Abstract]:Objective to analyze the changes of immune function and intestinal flora in patients with hematologic malignancies before and after chemotherapy, and to explore the relationship between immune function and intestinal microecology and infection after chemotherapy. Methods from January 2012 to December 2015, 120 patients with first malignant hematologic diseases who needed chemotherapy were selected and divided into infection group (n = 44) and non-infection group (n = 76) according to whether infection occurred after chemotherapy. Blood samples and stool samples were collected before and after chemotherapy to detect the levels of blood related immune cells and excretory immunoglobulin A (Siga) in feces, and to analyze the changes of intestinal flora. The colonization resistance (CR) was evaluated by the quantitative ratio of Bifidobacterium to Enterobacter coli (B / E). 缁撴灉鍖栫枟鍚，

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