目的: 通过系统评估了解口服益生菌对结直肠癌化疗患者肠道菌群影响。方法: 利用计算机通过网络检索中国知网( CNKI )、中国生物医学文献服务系统(Sinomed )、万方大数据知识服务平台(Wanfangdata )、维普中文数据库、 Pubmed 英文数据库、 Embase 英文数据库、 Cochrane library 英文数据库的文献资料,评价被纳入的随机对照研究,文献检索自建库终止于2021年4月。本文利用RevMan 5.3软件处理Meta分析。结果: 经过最终筛选获得5个RCT数据,共437例患者。Meta分析结果表明:与单纯化疗患者相比,口服益生菌制剂可以降低结直肠癌化疗患者的大肠杆菌含量(SMD=-2.04, P＜0.00001)、粪肠球菌含量(SMD=-2.20, P=0.002),提高乳酸杆菌含量(SMD=4.30, P＜0.00001)、双歧杆菌含量(SMD=3.32, P＜0.00001)。结论: 口服益生菌制剂的结直肠癌化疗患者与仅接受化疗患者相比可以提升肠道内有益菌含量,并且降低机会致病菌的含量,但其结果还需要大样本、高质量的研究加以论证。
Objective: To systematically assess the outcomes of oral probiotics on gastrointestinal microbiomes in patients of Colorectal Neoplasm undergoing colorectal chemotherapy. Methods: By using computer, we searched CNKI, SinoMed, WanFangData, VIP, PubMed,Embase and The Cochrane Library. The researched RCTs were then appraised from inchoation to April 2021 ,besides, Meta analysis was implemented using RevMan5.3 software. Results: The number of 5 RCTs comprising 437 patients were contained. These results from meta analysis supports the idea that contrasted with control group, patients undergoing colorectal chemotherapy with probiotics reduced the levels of Escherichia coli(SMD=-2.04,P＜0.00001)and En-terococcus faecalis(SMD=-2.20,P=0.002).Besides, there was statistical significance in the increase of levels of lactobacillus(SMD=4.30,P＜0.00001)and Bifidobacterium(SMD=3.32,P＜0.00001). Conclusion: The patients of Oral probiotics in undergoing chemotherapy for Colorectal Neoplasm can increase the number of beneficial bacteria in the enteric canal ,and lessen the number of opportunistic pathogens, however, the results needs further confirm by large samples and high quality research.
[1] 中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版)[J].中华外科杂志, 2020, 58(8):561-585.
[2] 韩文华, 钱昆. 直肠癌新辅助化疗后不同手术间隔时间对疗效及并发症的影响[J].实用癌症杂志, 2018, 33(9): 1448-1451.
[3] Kazmierczak-Siedlecka K, Ruszkowski J, Skonieczna-Zydecka K, et al. Gastrointestinal cancers: the role of microbiota in carcinogenesis and the role of probiotics and microbiota in anti-cancer therapy efficacy[J].Cent Eur J Immunol, 2020, 45(4):476-487.
[4] Gao ZG, Guo BM, Gao RY, et al. Probiotics modify human intestinal mucosa-associated microbiota in patientswith colorectal cancer[J].Mol Med Rep, 2015, 12(4): 6119-6127.
[5] Higgins JP, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions[M].New York :John Wiley & Sons Ltd,2019:205-228.
[6] 董建华, 程先硕, 杨之斌, 等. 双歧杆菌三联活菌胶囊联合奥沙利铂对结直肠癌术后的疗效及对肠道菌群与免疫功能的影响[J].西部医学, 2019, 31(3): 403-407.
[7] 刘灏, 刘永伟, 彭仁群, 等. 益生菌对结肠癌化疗患者肠道菌群的影响分析[J].世界最新医学信息文摘, 2019, 19(45): 56-59.
[8] 邵云娣, 路娜娜, 赵敏. 益生菌对结肠癌化疗患者肠道菌群及化疗相关并发症影响的研究[J].中国现代医生, 2018, 56(2): 23-26.
[9] 詹玉强. 益生菌对结肠癌化疗患者肠道菌群的影响[J].中国实用医药, 2018, 13(32): 105-107.
[10] 张艺璇, 周秀彦, 高湘曼. 益生菌干预对结肠癌患者术后化疗并发症、预后及肠道菌群的影响[J].现代消化及介入诊疗, 2020, 25(6): 768-771.
[11] Swidsinski A, Loening-Baucke V, Lochs H, et al. Spatial organization of bacterial flora in normal and inflamed intestine: A fluorescence in situ hybridization study in mice[J].World J Gastroenterol, 2005, 11(8): 1131-1140.
[12] Arenas-Hernández MM, Martínez-Laguna Y, Torres AG, et al. Clinical implications of enteroadherent Escherichia coli[J].Curr Gastroenterol Rep.,2012,14(5):386-394.
[13] Negarandeh R, Salehifar E, Saghafi F, et al. Evaluation of adverse effects of chemotherapy regimens of 5-fluoropyrimidines derivatives and their association with DPYD polymorphisms in colorectal cancer patients[J].BMC cancer, 2020, 20(1):560.
[14] Stecher B, Hardt W D.Mechanisms controlling pathogen colonization of the gut[J].Curr Opin Microbiol, 2011, 14(1): 82-91.
[15] Kazmierczak-Siedlecka K, Daca A, Fic M, et al. Therapeutic methods of gut microbiota modification in colorectal cancer management - fecal microbiota transplantation, prebiotics, probiotics, and synbiotics[J].Gut microbes,2020,11(6): 1518-1530.
