• 上海交通大學(xué)附屬第六人民醫(yī)院普外科(上海200233);

目的  研究益生菌對(duì)大腸癌術(shù)后患者腸屏障功能及炎癥反應(yīng)的影響。方法  60例擇期大腸癌手術(shù)患者分為益生菌組和對(duì)照組，每組各30例。分別于術(shù)后第3~7 d給予等氮量、等熱卡營(yíng)養(yǎng)支持。從術(shù)后第1 d起，益生菌組口服優(yōu)菌多2 g/d，共7 d。于術(shù)后每天觀察2組患者體溫及心率情況； 術(shù)前，術(shù)后第1、5、8 d分別進(jìn)行白細(xì)胞計(jì)數(shù)； 術(shù)前，術(shù)后第1、8 d檢測(cè)全血細(xì)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(yīng)綜合征（SIRS）和感染并發(fā)癥發(fā)生情況。結(jié)果  益生菌組術(shù)后發(fā)熱持續(xù)時(shí)間、術(shù)后5 d平均心率及白細(xì)胞計(jì)數(shù)恢復(fù)正常時(shí)間均明顯短于或低于對(duì)照組（P＜0.01）。術(shù)后第1 d 2組患者外周血細(xì)菌DNA檢測(cè)陽(yáng)性率差異無(wú)統(tǒng)計(jì)學(xué)意義； 第8 d對(duì)照組仍有7例（23.3%）PCR檢測(cè)呈陽(yáng)性，而益生菌組為1例（3.3%）,2組間差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。對(duì)照組血漿D-乳酸水平由術(shù)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(shí)2組間差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。對(duì)照組L/M比值由術(shù)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(shí)2組間差異有統(tǒng)計(jì)學(xué)意義(P＜0.01)。術(shù)后SIRS發(fā)生率及感染并發(fā)癥的發(fā)生率2組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P gt;0.05)。結(jié)論  益生菌能降低大腸癌患者術(shù)后腸道通透性，減少細(xì)菌易位，有利于大腸癌患者術(shù)后早期炎癥反應(yīng)的恢復(fù)。

引用本文： 夏 陽(yáng),秦環(huán)龍. 益生菌對(duì)大腸癌術(shù)后腸屏障功能及全身炎癥反應(yīng)的影響. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008, 15(11): 805-810. doi: 復(fù)制

1.
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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(nèi)IgA含量的變化 [Ｊ]. 創(chuàng)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(tài)制劑及其臨床應(yīng)用和研究進(jìn)展[Ｊ]. 中國(guó)普外基礎(chǔ)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(tài)制劑的進(jìn)展與臨床應(yīng)用評(píng)價(jià) [Ｊ]. 中國(guó)醫(yī)院用藥評(píng)價(jià)與分析, 2006; 6(3)∶139.
14. 范學(xué)工, 黃 燕. 微生態(tài)制劑的臨床應(yīng)用 [Ｊ].中國(guó)實(shí)用內(nèi)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(yán)， 等. 益生菌對(duì)肝硬化血氨影響的實(shí)驗(yàn)及臨床研究 [Ｊ]. 中國(guó)微生態(tài)學(xué)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(huán)龍， 蘇振東， 范小兵， 等. 益生菌對(duì)急性胰腺炎大鼠腸道微生態(tài)及緊密連接的影響 [Ｊ]. 中國(guó)臨床營(yíng)養(yǎng)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. 1.
  2. 2. 吳承堂， 黃祥成， 楊希山, 等. 大腸癌術(shù)后腸屏障功能變化的臨床研究 [Ｊ]. 中國(guó)普通外科雜志, 2003; 12（11）∶858.
  3. 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. 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. 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(nèi)IgA含量的變化 [Ｊ]. 創(chuàng)傷外科雜志, 2003; 5（2）∶122.
  6. 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. 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. 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. 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. 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. 11. 張 婧, 程 中. 腸道微生態(tài)制劑及其臨床應(yīng)用和研究進(jìn)展[Ｊ]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2008; 15(6)∶463.
  12. 12. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition[Ｊ]. Am J Clin Nutr， 2001; 73(2 Suppl)∶361S.
  13. 13. 劉東紅. 微生態(tài)制劑的進(jìn)展與臨床應(yīng)用評(píng)價(jià) [Ｊ]. 中國(guó)醫(yī)院用藥評(píng)價(jià)與分析, 2006; 6(3)∶139.
  14. 14. 范學(xué)工, 黃 燕. 微生態(tài)制劑的臨床應(yīng)用 [Ｊ].中國(guó)實(shí)用內(nèi)科雜志, 2002; 22(11)∶691.
  15. 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. 16. 卜淑蕊， 戴 鵬， 趙 嚴(yán)， 等. 益生菌對(duì)肝硬化血氨影響的實(shí)驗(yàn)及臨床研究 [Ｊ]. 中國(guó)微生態(tài)學(xué)雜志, 2007； 19（1）∶25.
  17. 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. 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. 19. Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy[Ｊ].Hepatogastroenterology， 2007; 54(75)∶661.
  20. 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. 21. 秦環(huán)龍， 蘇振東， 范小兵， 等. 益生菌對(duì)急性胰腺炎大鼠腸道微生態(tài)及緊密連接的影響 [Ｊ]. 中國(guó)臨床營(yíng)養(yǎng)雜志， 2006； 14（2）∶82.
  22. 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.