益生菌對大腸癌術后腸屏障功能及全身炎癥反應的影響_《中國普外基礎與臨床雜志》

作者：

夏陽 , 秦環龍

上海交通大學附屬第六人民醫院普外科(上海200233);

關鍵詞：

益生菌腸道通透性腸屏障功能結直腸腫瘤

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目的研究益生菌對大腸癌術后患者腸屏障功能及炎癥反應的影響。方法 60例擇期大腸癌手術患者分為益生菌組和對照組，每組各30例。分別于術后第3~7 d給予等氮量、等熱卡營養支持。從術后第1 d起，益生菌組口服優菌多2 g/d，共7 d。于術后每天觀察2組患者體溫及心率情況；術前，術后第1、5、8 d分別進行白細胞計數；術前，術后第1、8 d檢測全血細菌DNA、血漿D-乳酸水平及尿乳果糖/甘露醇（L/M）比值；觀察2組患者全身炎癥反應綜合征（SIRS）和感染并發癥發生情況。結果益生菌組術后發熱持續時間、術后5 d平均心率及白細胞計數恢復正常時間均明顯短于或低于對照組（P＜0.01）。術后第1 d 2組患者外周血細菌DNA檢測陽性率差異無統計學意義；第8 d對照組仍有7例（23.3%）PCR檢測呈陽性，而益生菌組為1例（3.3%）,2組間差異有統計學意義(P＜0.05)。對照組血漿D-乳酸水平由術后第1 d的(6.63±1.29) ng/ml下降至第8 d的（0.95±0.83） ng/ml，而益生菌組則由（6.90±1.41） ng/ml下降至(0.56±0.18) ng/ml,第8 d時2組間差異有統計學意義(P＜0.05)。對照組L/M比值由術后第1 d的0.053±0.019升高至第8 d的0.063±0.016,益生菌組則由0.047±0.012 降至0.031±0.008, 第8 d時2組間差異有統計學意義(P＜0.01)。術后SIRS發生率及感染并發癥的發生率2組間差異無統計學意義(P gt;0.05)。結論益生菌能降低大腸癌患者術后腸道通透性，減少細菌易位，有利于大腸癌患者術后早期炎癥反應的恢復。

引用本文： 夏陽,秦環龍. 益生菌對大腸癌術后腸屏障功能及全身炎癥反應的影響. 中國普外基礎與臨床雜志, 2008, 15(11): 805-810. doi: 復制

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8.	Meddings JB, Swain MG. Environmental stress-induced gastrointestinal permeability is mediated by endogenous glucocorticoids in the rat[Ｊ]. Gastroenterology, 2000; 119(4)∶1019.
9.	Deitch EA. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure[Ｊ]. Arch Surg, 1990; 125(3)∶403.
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12.	Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition[Ｊ]. Am J Clin Nutr， 2001; 73(2 Suppl)∶361S.
13.	劉東紅. 微生態制劑的進展與臨床應用評價 [Ｊ]. 中國醫院用藥評價與分析, 2006; 6(3)∶139.
14.	范學工, 黃燕. 微生態制劑的臨床應用 [Ｊ].中國實用內科雜志, 2002; 22(11)∶691.
15.	Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis[Ｊ].Med Sci Monit， 2004; 10(11)∶PI126.
16.	卜淑蕊，戴鵬，趙嚴，等. 益生菌對肝硬化血氨影響的實驗及臨床研究 [Ｊ]. 中國微生態學雜志, 2007； 19（1）∶25.
17.	Oláh A, Belágyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis[Ｊ]. Br J Surg， 2002; 89(9)∶1103.
18.	Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predict severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[Ｊ]. Lancet, 2008； 371(9613)∶651.
19.	Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy[Ｊ].Hepatogastroenterology， 2007; 54(75)∶661.
20.	Rayes N, Seehofer D, Müller AR, et al. Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery-results of a prospective trial[Ｊ]. Z Gastroenterol， 2002; 40(10)∶869.
21.	秦環龍，蘇振東，范小兵，等. 益生菌對急性胰腺炎大鼠腸道微生態及緊密連接的影響 [Ｊ]. 中國臨床營養雜志， 2006； 14（2）∶82.
22.	Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[Ｊ]. Gut， 2004; 53(2)∶241.

1.
2. 吳承堂，黃祥成，楊希山, 等. 大腸癌術后腸屏障功能變化的臨床研究 [Ｊ]. 中國普通外科雜志, 2003; 12（11）∶858.
3. Klarin B, Johansson ML, Molin G, et al. Adhesion of the probiotic bacterium Lactobacillus plantarum 299v onto the gut mucosa in critically ill patients: a randomised open trial[Ｊ]. Crit Care, 2005; 9(3)∶R285.
4. Kane TD, Alexander JW, Johannigman JA. The detection of microbial DNA in the blood: a sensitive method for diagnosing bacteremia and/or bacterial translocation in surgical patients[Ｊ]. Ann Surg, 1998; 227(1)∶1.
5. 于勇，盛志勇，柴家科，等. 燒傷患者血漿D-乳酸水平和腸道內IgA含量的變化 [Ｊ]. 創傷外科雜志, 2003; 5（2）∶122.
6. Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[Ｊ]. Crit Care Med, 1992; 20(6)∶864.
7. Madara JL. Maintenance of the macromolecular barrier at cell extrusion sites in intestinal epithelium: physiological rearrangement of tight junctions[Ｊ]. J Membr Biol, 1990; 116(2)∶177.
8. Meddings JB, Swain MG. Environmental stress-induced gastrointestinal permeability is mediated by endogenous glucocorticoids in the rat[Ｊ]. Gastroenterology, 2000; 119(4)∶1019.
9. Deitch EA. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure[Ｊ]. Arch Surg, 1990; 125(3)∶403.
10. Sderholm JD, Perdue MH. Stress and gastrointestinal tract.Ⅱ. Stress and intestinal barrier function[Ｊ]. Am J Physiol Gastrointest Liver Physiol， 2001； 280(1)∶G7.
11. 張婧, 程中. 腸道微生態制劑及其臨床應用和研究進展[Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6)∶463.
12. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition[Ｊ]. Am J Clin Nutr， 2001; 73(2 Suppl)∶361S.
13. 劉東紅. 微生態制劑的進展與臨床應用評價 [Ｊ]. 中國醫院用藥評價與分析, 2006; 6(3)∶139.
14. 范學工, 黃燕. 微生態制劑的臨床應用 [Ｊ].中國實用內科雜志, 2002; 22(11)∶691.
15. Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis[Ｊ].Med Sci Monit， 2004; 10(11)∶PI126.
16. 卜淑蕊，戴鵬，趙嚴，等. 益生菌對肝硬化血氨影響的實驗及臨床研究 [Ｊ]. 中國微生態學雜志, 2007； 19（1）∶25.
17. Oláh A, Belágyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis[Ｊ]. Br J Surg， 2002; 89(9)∶1103.
18. Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predict severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[Ｊ]. Lancet, 2008； 371(9613)∶651.
19. Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy[Ｊ].Hepatogastroenterology， 2007; 54(75)∶661.
20. Rayes N, Seehofer D, Müller AR, et al. Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery-results of a prospective trial[Ｊ]. Z Gastroenterol， 2002; 40(10)∶869.
21. 秦環龍，蘇振東，范小兵，等. 益生菌對急性胰腺炎大鼠腸道微生態及緊密連接的影響 [Ｊ]. 中國臨床營養雜志， 2006； 14（2）∶82.
22. Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[Ｊ]. Gut， 2004; 53(2)∶241.

《中國普外基礎與臨床雜志》

益生菌對大腸癌術后腸屏障功能及全身炎癥反應的影響

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《中國普外基礎與臨床雜志》

益生菌對大腸癌術后腸屏障功能及全身炎癥反應的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料