本文關(guān)鍵詞： 惡性腫瘤化療 腸道菌群 糞便菌群培養(yǎng)　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:癌癥的治療主要以手術(shù)、放化療、靶向藥物、生物免疫療法及中醫(yī)中藥等方法為主,其中化療作為抗癌治療的一項(xiàng)重要手段,一些腫瘤會得到不同程度的控制,延長病人生命,然而,化療后出現(xiàn)的血液學(xué)毒性,胃腸道毒性,器官毒性損害,脫發(fā),靜脈炎以及與化療相關(guān)的疲勞性等副反應(yīng),限制了化療藥物的使用,其中有研究表明化療后出現(xiàn)的一部分的胃腸道毒性與腸道菌群紊亂有關(guān)。因此對接受化療的惡性腫瘤患者腸道菌群的定量分析,有助于從微生態(tài)角度了解化療藥物對腸道菌群的影響程度,并為微生態(tài)調(diào)節(jié)劑用于預(yù)防、減輕及治療化療引起的腸道菌群紊亂、化療相關(guān)性腸炎及化療相關(guān)性腹瀉(CID)等副作用提供依據(jù)。本研究選取雙歧桿菌、大腸桿菌、梭桿菌三種具有代表性菌種,留取接受化療的惡性腫瘤患者糞便,隨機(jī)分成兩組,一組單純化療的對照組,另一組化療過程中給予雙歧桿菌菌調(diào)藥物的實(shí)驗(yàn)組,通過糞便培養(yǎng)對在化療前后腸道中上述菌群的變化定量分析,以了解化療患者腸道內(nèi)雙歧桿菌、大腸桿菌、梭桿菌的菌量變化,對照組與實(shí)驗(yàn)組比較,了解雙歧桿菌、大腸桿菌、梭桿菌的菌量是否有變化,探討化療藥物是否對腸道微生態(tài)造成破環(huán),最終達(dá)到可否用微生態(tài)調(diào)節(jié)劑預(yù)防或減輕患者化療過程中各種腸源性副反應(yīng)的目的,從而保證化療的順利進(jìn)行,提高治療水平,延長患者生命。方法:1.分組:選擇2015年01月-2016年10月解放軍第210醫(yī)院腫瘤科收治的115例Ⅳ期惡性腫瘤化療患者,其中肺癌38例、胃癌16例、乳腺癌30例、食管癌5例、胰腺癌7例及大腸癌19例,化療方案為IP、DP、DCF、XT、TXT、FOLFOX、FOLFIRI、XELOX方案,隨機(jī)分為兩組,56例作為實(shí)驗(yàn)組,59例對照組。實(shí)驗(yàn)組口服雙歧三聯(lián)活菌腸溶膠囊,以上選擇對象入組前2周內(nèi)均無抗生素應(yīng)用史及除腫瘤外的其他胃腸疾病史,實(shí)驗(yàn)組及對照組不少于四周期化療。2.標(biāo)本:實(shí)驗(yàn)組及對照組取入組后第一周期化療前、第四周期化療前、第四周期化療第7天和14天糞便標(biāo)本,通過培養(yǎng)基改良和培養(yǎng)鑒定方法對留取的糞便進(jìn)行腸道菌群定量分析。結(jié)果:通過檢測四周期化療過程中患者糞便標(biāo)本中雙歧桿菌、大腸桿菌、梭桿菌三種菌群的數(shù)量,我們發(fā)現(xiàn)對照組化療三周期后腸道內(nèi)雙歧桿菌及大腸桿菌明顯減少,梭桿菌數(shù)量增加;使用微生態(tài)制劑的實(shí)驗(yàn)組患者腸道菌群無明顯變化,臨床觀察發(fā)現(xiàn)實(shí)驗(yàn)組腹瀉、腹痛、便秘等消化道反應(yīng)明顯減輕,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.化療藥物抑制腸道正常菌群生長,加重腸道菌群失調(diào)。2.化療期間給予益生菌制劑,有助于增強(qiáng)體內(nèi)腸道菌群平衡,減輕腸道菌群失調(diào)程度,減輕消化道反應(yīng)及腸道黏膜炎癥。
[Abstract]:Objective: the treatment of cancer mainly consists of surgery, radiotherapy and chemotherapy, targeted drugs, biological immunotherapy and traditional Chinese medicine, among which chemotherapy is an important means of anticancer treatment, and some tumors will be controlled to varying degrees. However, side effects such as hematological toxicity, gastrointestinal toxicity, organ toxicity, alopecia, phlebitis and chemotherapy-related fatigue after chemotherapy limit the use of chemotherapy drugs. Some studies have shown that some of the gastrointestinal toxicity after chemotherapy is related to intestinal microflora disorder. It is helpful to understand the influence of chemotherapeutic drugs on intestinal flora from the microecological point of view, and to be used as a microecological regulator to prevent, mitigate and treat intestinal microflora disorders caused by chemotherapy. In this study, bifidobacterium, Escherichia coli and Clostridium spp. Three representative bacteria were collected from the feces of malignant tumor patients who received chemotherapy, and were randomly divided into two groups. One group was treated with chemotherapy alone, the other group was treated with bifidobacterium in the course of chemotherapy. The bifidobacterium in the intestinal tract was quantitatively analyzed by fecal culture before and after chemotherapy, in order to understand the bifidobacterium in the intestinal tract of the patients with chemotherapy. The bacteria quantity of Escherichia coli and Clostridium spp. The control group was compared with the experimental group to find out if there were any changes in the bacteria quantity of Bifidobacterium, Escherichia coli and Clostridium, and to explore whether the chemotherapeutic drugs had broken down the intestinal microecology. Finally, it is possible to use microecological regulators to prevent or alleviate various enterogenic side effects in the course of chemotherapy in patients, so as to ensure the smooth progress of chemotherapy and improve the treatment level. From January 2015 to October 2016, 115 patients with stage 鈪，

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