目的

探讨肝癌术后感染患者肠道菌群特征与机体炎症、免疫功能及肠道功能的相关性。

方法

回顾性分析山东省立第三医院2022 年1 月至2023 年12 月接诊的126 例肝癌手术患者临床资料，根据患者术后是否出现感染分为感染组（n=25）和对照组（n=101）。比较两组患者肠道菌群、机体炎症指标[白细胞介素（IL）-6、IL-8、降钙素原（PCT）、C 反应蛋白（CRP）]、免疫功能指标（CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺）、肠道功能指标[二胺氧化酶（DAO）、D-乳酸]水平，采用Pearson 相关分析法分析肝癌术后感染患者肠道菌群特征与机体炎症、免疫功能及肠道功能的相关性。

结果

感染组患者肠球菌水平明显高于对照组，拟杆菌、乳酸杆菌、双歧杆菌水平均明显低于对照组，差异有统计学意义（P＜0.05）；感染组患者的血清IL-6、IL-8、PCT、CRP 水平均明显高于对照组，CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺水平均明显低于对照组，差异有统计学意义（P＜0.05）；感染组患者DAO、D-乳酸水平均明显高于对照组，差异有统计学意义（P＜0.05）。Pearson 相关分析显示，肝癌术后感染患者肠球菌与IL-6、IL-8、PCT、CRP、DAO、D-乳酸水平呈正相关，与CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺水平呈负相关（P＜0.05）；拟杆菌、乳酸杆菌、双歧杆菌与IL-6、IL-8、PCT、CRP、DAO、D-乳酸水平呈负相关，与CD₃⁺、CD₄⁺、CD₄⁺/CD₈⁺水平呈正相关（P＜0.05）。

结论

肝癌术后感染患者肠道菌群肠球菌增殖、拟杆菌减少、乳酸杆菌和双歧杆菌减少，均与炎症因子的升高、免疫功能下降和肠道功能受损密切相关。通过调节这些菌群的平衡，可以减少炎症反应，改善免疫功能，增强肠道屏障，降低术后并发症的风险。

Objective

To investigate the relationship between intestinal flora characteristics and inflammation, immune function and intestinal function in patients with postoperative infection of liver cancer.

Methods

The medical records of 126 patients with liver cancer treated in Shandong Provincial Third Hospital from January 2022 to December 2023 were retrospectively analyzed, and the patients were divided into infection group (n=25) and control group (n=101) according to whether they had infection after surgery.Intestinal flora, inflammatory indicators [interleukin (IL)-6, IL-8, procalcitonin (PCT),C-reactive protein (CRP)], immune function indicators (CD3⁺, CD4⁺, CD4⁺/CD8⁺), intestinal function indicators [diamine oxidase (DAO), D-lactic acid] of the two groups were compared.In addition, Pearson correlation analysis was used to analyze the correlation between intestinal flora characteristics and body inflammation, immune function and intestinal function in postoperative infected patients with liver cancer.

Results

The level of Enterococcus in the infected group was significantly higher than that in the control group, while the levels of Bacteroides, Lactobacillus and Bifidobacterium were significantly lower than those in the control group, with statistically significant differences (P<0.05).The levels of IL-6, IL-8, PCT and CRP in the infected group were significantly higher than those in the control group, and the levels of CD₃⁺, CD₄⁺ and CD₄⁺/CD₈⁺ were significantly lower than those in the control group, with statistically significant differences (P<0.05).The levels of DAO and D-lactate in the infected group were significantly higher than those in the control group, with statistically significant differences (P<0.05).Pearson correlation analysis showed that Enterococcus in patients with postoperative infection of liver cancer was positively correlated with the levels of IL-6, IL-8, PCT, CRP, DAO, and D-lactic acid, and negatively correlated with the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ (P<0.05).Bacteroides, Lactobacillus and Bifidobacterium were negatively correlated with the levels of IL-6, IL-8, PCT, CRP, DAO and D-lactic acid, and positively correlated with the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ (P<0.05).

Conclusion

The proliferation of Enterococcus, the decrease of Bacteroides, and the decrease of Lactobacillus and Bifidobacterium in the intestinal flora of patients with postoperative infection of liver cancer are closely related to the increase of inflammatory factors, the decrease of immune function and the impairment of intestinal function.By regulating the balance of these flora, inflammatory responses can be reduced,immune function can be improved, intestinal barrier can be strengthened, and the risk of postoperative complications can be reduced.