【摘要】：目的分析惡性血液病患者化療前后機(jī)體免疫功能和腸道菌群的變化,探討機(jī)體免疫功能及腸道微生態(tài)與化療后并發(fā)感染的相關(guān)性。方法選擇2012年1月-2015年12月無錫市第二人民醫(yī)院收治的120例首發(fā)惡性血液病且需要化療的患者,根據(jù)化療后是否發(fā)生感染分為感染組(44例)和無感染組(76例)。于化療前后留取患者血樣和糞便標(biāo)本,檢測血液相關(guān)免疫細(xì)胞水平及糞便標(biāo)本中分泌性免疫球蛋白A(sIgA)水平;分析腸道菌群變化,以雙歧桿菌與腸桿菌的數(shù)量比值(B/E值)評價(jià)腸道定植抗力(CR)。結(jié)果化療后,感染組患者外周血白細(xì)胞[(2.26±0.55)109/L]、中性粒細(xì)胞[(0.61±0.04)109/L]、CD3+[(25.51±3.23)%]、CD4+[(13.62±4.53)%]、CD4+/CD8+[(0.59±0.22)%]及sIgA水平[(0.58±0.07)g/L]均顯著低于化療前(t分別為-33.737、-55.831、-15.019、-11.182、-13.007、-28.387,P均0.05)和化療后無感染組(t分別為-14.947、-74.774、-10.845、-4.661、-5.447、-21.696,P均0.05);與化療前比,化療后感染組患者糞便標(biāo)本腸桿菌[(9.97±1.01)lg CFU/g]、腸球菌[(9.88±0.55)lg CFU/g]、不動(dòng)桿菌[(7.84±0.70)lg CFU/g]、假單胞細(xì)菌[(5.11±0.89)lg CFU/g]及真菌[(9.54±0.87)lg CFU/g]菌落數(shù)顯著增多(t分別為8.205、4.876、6.791、7.028、6.588,P均0.05),雙歧桿菌[(5.24±0.37)lg CFU/g]和乳酸桿菌[(2.37±0.36)lg CFU/g]菌落數(shù)顯著減少(t分別為-13.358、-48.641,P均0.05);且感染組較無感染組腸球菌、不動(dòng)桿菌及真菌菌落數(shù)增加及雙歧桿菌和乳酸桿菌菌落數(shù)減少更顯著(t分別為3.717、6.510、5.384、-5.103、-11.028,P均0.05);感染組化療后B/E值(0.53±0.07)顯著小于化療前(t=-12.903,P0.05)和無感染組化療后(t=-6.131,P0.05)。結(jié)論惡性血液病患者化療后機(jī)體免疫功能下降,腸道菌群紊亂,CR下降,造成免疫穩(wěn)態(tài)失衡,患者發(fā)生感染的風(fēng)險(xiǎn)增加。
[Abstract]:Objective to analyze the changes of immune function and intestinal flora in patients with hematologic malignancies before and after chemotherapy, and to explore the relationship between immune function and intestinal microecology and infection after chemotherapy. Methods from January 2012 to December 2015, 120 patients with first malignant hematologic diseases who needed chemotherapy were selected and divided into infection group (n = 44) and non-infection group (n = 76) according to whether infection occurred after chemotherapy. Blood samples and stool samples were collected before and after chemotherapy to detect the levels of blood related immune cells and excretory immunoglobulin A (Siga) in feces, and to analyze the changes of intestinal flora. The colonization resistance (CR) was evaluated by the quantitative ratio of Bifidobacterium to Enterobacter coli (B / E). 緇撴灉鍖栫枟鍚，

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