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中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (01) : 53 -56. doi: 10.3877/cma.j.issn.2095-2015.2024.01.009

论著

肠道菌群特征对结肠癌化学治疗疗效的影响
谢鸿1, 李娜2, 李尚日1, 谢涛3,†()   
  1. 1. 435002　湖北省，黄石市第二医院消化内科
    2. 435002　湖北省，黄石市第二医院医疗部
    3. 435002　湖北省，黄石市第二医院麻醉科
  • 收稿日期:2023-04-17 出版日期:2024-02-01
  • 通信作者: 谢涛

Effect of intestinal flora characteristics on the therapeutic effect of different chemotherapy regimens for colorectal cancer

Hong Xie1, Na Li2, Shangri Li1, Tao Xie3,†()   

  1. 1. Department of Gastroenterology, Huangshi Second Hospital, Huangshi 435002, China
    2. Medical Department, Huangshi Second Hospital, Huangshi 435002, China
    3. Department of Anesthesiology, Huangshi Second Hospital, Huangshi 435002, China
  • Received:2023-04-17 Published:2024-02-01
  • Corresponding author: Tao Xie
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谢鸿, 李娜, 李尚日, 谢涛. 肠道菌群特征对结肠癌化学治疗疗效的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(01): 53-56.

Hong Xie, Na Li, Shangri Li, Tao Xie. Effect of intestinal flora characteristics on the therapeutic effect of different chemotherapy regimens for colorectal cancer[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(01): 53-56.

目的

探讨肠道菌群特征对晚期结肠癌患者不同化学治疗（化疗）方案治疗效果的影响。

方法

采用前瞻性病例对照分析，选取2019年6月至2020年11月黄石市第二医院收治248例Ⅳ期结肠癌患者，其中采用卡培他滨＋奥沙利铂（XELOX）化疗方案治疗者130例，随机分为XELOX联合组（XELOX＋双歧杆菌乳杆菌三联活菌片）、XELOX组两组；采用奥沙利铂＋亚酸钙＋5-氟尿嘧啶（FOLFOX）化疗方案治疗者118例，随机分为FOLFOX联合组（FOLFOX＋双歧杆菌乳杆菌三联活菌片）、FOLFOX组。检测各组治疗前后粪便标本中肠道菌群，并比较各组临床治疗效果。

结果

XELOX联合组较XELOX组治疗后双歧杆菌、乳酸杆菌、类杆菌较治疗前明显增多，肠杆菌、肠球菌、梭杆菌较治疗前明显减少（P<0.05）；FOLFOX联合组较FOLFOX组治疗后双歧杆菌、乳酸杆菌、类杆菌较治疗前明显增多，肠杆菌、肠球菌、梭杆菌较治疗前明显减少（P<0.05）。XELOX联合组总有效率明显优于XELOX组（56.92%比43.08%，P<0.05），随访12个月期间死亡率明显低于XELOX组（21.54%比49.23%，P<0.05）；FOLFOX联合组总有效率明显优于FOLFOX组（52.54%比44.07%，P<0.05），随访12个月期间死亡率明显低于FOLFOX组（22.03%比57.63%，P<0.05）。

结论

晚期结肠癌存在明显的肠道菌群失调情况，接受不同化疗方案治疗的晚期结肠癌患者同时予以调节肠道菌群的药物干预，可提高治疗效果，改善患者的生存情况。

关键词: 结肠癌, 肠道菌群, 化学治疗, 疗效, 预后
Objective

To explore the influence of intestinal flora characteristics on the therapeutic effect of different chemotherapy regimens for colorectal cancer.

Methods

A prospective case-control analysis was conducted to select 248 patients with stage Ⅳ colon cancer admitted to the Second Hospital of Huangshi City from June 2019 to November 2020. Among them, 130 patients treated with capecitabine+oxaliplatin (XELOX) chemotherapy regimen were randomly divided into two groups: XELOX combination group (XELOX+bifidobacterium lactobacillus triple live bacterial tablets) and XELOX group; 118 patients treated with oxaliplatin+calcium nitrite+5-fluorouracil (FOLFOX) chemotherapy regimen were randomly divided into two groups: the FOLFOX combination group (FOLFOX+ bifidobacterium lactobacillus triple live bacterial tablets) and the FOLFOX group. The gut microbiota in fecal samples before and after treatment in each group were detected, and the clinical treatment effects of each group were compared.

Results

Compared with the XELOX group, bifidobacteria, lactobacilli and bacteroides in the XELOX combination group increased significantly after treatment, while enterobacteria, enterococcus and fusobacterium decreased significantly (P<0.05); Compared with the FOLFOX group, bifidobacteria, lactobacilli and bacteroides in the FOLFOX combination group were significantly increased after treatment, while enterobacteria, enterococcus and fusobacterium were significantly reduced after treatment (P<0.05). The total effective rate of the XELOX combination group was significantly higher than that of the XELOX group (56.92% vs. 43.08%, P<0.05), and the mortality rate during the 12 month follow-up period was significantly lower than that of the XELOX group (21.54% vs. 49.23%, P<0.05); The total effective rate of the FOLFOX combination group was significantly better than that of the FOLFOX group (52.54% vs. 44.07%, P<0.05), and the mortality rate during the 12 month follow-up period was significantly lower than that of the FOLFOX group (22.03% vs. 57.63%, P<0.05).

Conclusion

There is a significant imbalance of intestinal flora in patients with advanced colon cancer. Drug intervention to regulate intestinal flora can improve the treatment effect and improve the survival of patients.

Key words: Colon cancer, Intestinal flora, Chemotherapy, Clinical effect, Prognosis
表1 4组患者治疗前后粪便中肠道菌群数比较（±s，Log10）
时间 组别 例数 双歧杆菌 乳酸杆菌 肠杆菌 肠球菌 类杆菌 梭杆菌
治疗前 XELOX联合组 65 7.09±0.78 6.49±0.72 9.31±0.82 8.05±1.43 7.19±0.75 9.91±0.54
XELOX组 65 7.16±0.63 6.68±0.85 9.48±0.74 8.12±1.65 7.29±0.52 9.86±0.77
FOLFOX联合组 59 7.05±0.81 6.62±0.63 9.33±1.02 8.22±1.31 7.21±0.71 9.89±0.52
FOLFOX组 59 7.03±0.75 6.67±0.75 9.41±0.84 8.03±1.62 7.09±0.88 9.68±0.65
F     0.482 0.187 0.337 0.692 0.731 0.381
P     0.318 0.429 0.581 0.264 0.172 0.601
治疗后 XELOX联合组 65 8.19±0.61ab 8.11±0.81ab 8.47±1.28ab 7.28±0.94ab 8.81±0.73ab 8.22±0.09ab
XELOX组 65 7.09±0.95 6.68±0.91 9.31±1.01 8.32±1.62 7.01±0.85 9.91±0.70
FOLFOX联合组 59 8.11±0.72ac 8.07±0.73ac 8.37±1.31ac 7.39±1.06ac 8.89±0.65ac 8.27±1.06ac
FOLFOX组 59 7.05±0.84 6.72±0.83 9.40±0.89 8.24±1.55 7.11±0.82 9.82±0.65
F     3.281 3.932 2.819 4.810 4.012 3.109
P     0.018 0.016 0.029 0.003 0.007 0.013
表2 4组患者临床疗效及死亡率比较[例（%）]
组别 例数 CR PR SD PD 总有效率 死亡率
XELOX联合组 65 9(13.85) 28(43.08) 22(33.85) 6(9.23) 37(56.92)a 14(21.54)a
XELOX组 65 5(7.69) 21(32.31) 28(43.08) 9(13.85) 28(43.08) 32(49.23)
FOLFOX联合组 59 8(13.56) 23(38.98) 21(35.59) 7(11.86) 31(52.54)b 13(22.03)b
FOLFOX组 59 4(6.78) 22(37.29) 23(38.98) 10(16.95) 26(44.07) 34(57.63)
χ2           21.572 34.071
P           0.001 0.001
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