切换至 "中华医学电子期刊资源库"
高级检索
中华消化病与影像杂志(电子版)

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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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]. 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]. 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
[1]
Teufel A, Li M, Gerken M, et al. Second Cancer After Additive Chemotherapy in Patients With Colon Cancer[J]. Clin Colorectal Cancer, 2022, 21(4): 354-361.
[2]
Rios-Valencia J, Cruz-Reyes C, Galindo-García TA, et al. Mismatch repair system in colorectal cancer. Frequency, cancer phenotype, and follow-up[J]. Rev Gastroenterol Mex(Engl Ed), 2022, 87(4): 432-438.
[3]
Torregrosa C, Pernot S, Vaflard P, et al. FOLFIRI plus BEvacizumab or aFLIbercept after FOLFOX-bevacizumab failure for COlorectal cancer(BEFLICO): An AGEO multicenter study[J]. Int J Cancer, 2022, 151(11): 1978-1988.
[4]
韩震, 王靖, 李卉, 等. 双歧杆菌联合辅助化疗对结直肠癌患者肠道菌群及免疫功能的影响[J]. 中国医学创新, 2022, 19(1): 29-33.
[5]
Ichikawa N, Homma S, Funakoshi T, et al. The survival impact of preoperative FOLFOX for resectable locally advanced rectal cancer: the R-NAC-01 study[J]. Surg Today, 2022, 52(8): 1134-1142.
[6]
Al Sabbagh C, Agapova E, Boudy V, et al. Stability of calcium levofolinate, 5-fluorouracil and oxaliplatin(FOLFOX) mixture[J]. J Oncol Pharm Pract, 2022, 28(6): 1303-1314.
[7]
Cavalleri T, Greco L, Rubbino F, et al. Tumor-associated macrophages and risk of recurrence in stage III colorectal cancer[J]. J Pathol Clin Res, 2022, 8(4): 307-312.
[8]
Fernández Montes A, Élez E, Vivancos A, et al. Monitoring of RAS mutant clones in plasma of patients with RAS mutant metastatic colorectal cancer[J]. Clin Transl Oncol, 2022, 24(6): 1209-1214.
[9]
张艺璇, 周秀彦, 高湘曼. 益生菌干预对结肠癌患者术后化疗并发症,预后及肠道菌群的影响[J]. 现代消化及介入诊疗, 2020, 25(6): 768-771.
[10]
Zhang J, Chen Y, Sun Y, et al. Plateau hypoxia attenuates the metabolic activity of intestinal flora to enhance the bioavailability of nifedipine[J]. Drug Delivery, 2018, 25(1): 1175-1181.
[11]
Guo J, Huang L. Formulation of two lipid-based membrane-core nanoparticles for FOLFOX combination therapy[J]. Nat Protoc, 2022, 17(8): 1818-1831.
[12]
Sun L, Zhang X, Gong P, et al. Clinical Efficacy of Bevacizumab Plus XELOX Chemotherapy in Colorectal Cancer and Application Value of Mindfulness-Based Stress Reduction Intervention[J]. Altern Ther Health Med, 2022, 28(6): 65-71.
[13]
杨祎, 王娜, 贾菲, 等. 益髓健脾汤联合XELOX方案治疗结肠癌术后患者对肠道菌群及预后影响分析[J]. 世界中西医结合杂志, 2023, 18(2): 392-395.
[14]
Wang F, He MM, Xiao J, et al. Randomized, Open-Label, Multicenter, Phase 3 Study of High-Dose Vitamin C Plus FOLFOX ± Bevacizumab versus FOLFOX ± Bevacizumab in Unresectable Untreated Metastatic Colorectal Cancer(VITALITY Study)[J]. Clin Cancer Res, 2022, 28(19): 4232-4239.
[15]
Zhou M, Thompson TD, Lin HY, et al. Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients[J]. Clin Colorectal Cancer, 2022, 21(2): e62-e75.
[16]
杨祎, 何颖华, 贾菲, 等. 双歧杆菌三联活菌胶囊联合FOLFOX方案用于结直肠癌术后对肠道微生态及抗肿瘤免疫应答的影响[J]. 湖南师范大学学报(医学版), 2022, 19(1): 95-98.
[17]
陈启仪, 田宏亮, 杨波, 等. 不同肠道准备方式对菌群移植疗效及安全性的影响[J]. 中华胃肠外科杂志, 2020, 23(Z1): 48-55.
[1] 王晓梅, 刘冰, 马丽琼, 卢祖静, 苗建军. 基于LASSO-Cox回归分析的非轻症急性胰腺炎死亡风险列线图预测模型的建立和临床应用效果分析[J]. 中华普通外科学文献(电子版), 2024, 18(01): 44-50.
[2] 刘政宏, 王凤力, 吉亚君, 高佳. 胃癌中ELK3蛋白的表达与临床病理特征和预后的关系研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 155-159.
[3] 钟文涛, 吕远, 孙亮, 袁强, 聂玉辉, 东星, 陈光, 陈纲, 杜峻峰. 腹腔镜-胃镜联合手术与开腹手术处理胃间质瘤的临床疗效对比研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 164-166.
[4] 张琳, 李婷. CRIP1在胃癌中的表达及与临床病理指标和预后的关系研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 171-175.
[5] 鲁鑫, 杨琴, 许佳怡. 不同术式治疗恶性梗阻性黄疸疗效及对免疫功能的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(02): 180-183.
[6] 姚宏伟, 魏鹏宇, 高加勒, 张忠涛. 不断提高腹腔镜右半结肠癌D3根治术的规范化[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 1-4.
[7] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[8] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[9] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[10] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[11] 黄金灿, 王迪, 崔松平, 陈晴, 吕少诚, 贺强, 郎韧. 预后营养指数对交界可切除胰腺癌患者术后预后的预测价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 51-56.
[12] 刘萍, 刘占举, 张萃. 英夫利西单抗治疗克罗恩病的临床疗效及影响因素[J]. 中华消化病与影像杂志(电子版), 2024, 14(01): 28-34.
[13] 蒲蕾, 冯韵霖, 洪大情, 何强, 李贵森, 陈瑾. 蛋白质-能量消耗对血液透析患者预后的影响[J]. 中华临床医师杂志(电子版), 2023, 17(10): 1051-1057.
[14] 李越, 周祺祺, 赵洪猛. 初诊Ⅳ期乳腺癌的外科治疗进展[J]. 中华临床医师杂志(电子版), 2023, 17(10): 1097-1101.
[15] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(09): 962-967.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号