摘要
目的探究伤口感染对胃癌根治术后患者营养状况、胃肠道功能及肠道菌群的影响。方法选取2018年1月-2021年12月海口市第三人民医院胃癌根治术后伤口感染患者52例为感染组,并选取同期术后未发生感染患者50例为对照组。比较两组营养指标(白蛋白、前白蛋白和血红蛋白)、炎症因子[C反应蛋白(CRP)、白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)]、胃肠功能指标[胃泌素、胃动素、二胺氧化酶(DAO)和D-乳酸]及肠道菌群情况(大肠埃希菌、乳酸杆菌、双歧杆菌和肠球菌)。结果与术前比较,术后3 d两组患者血清白蛋白、前白蛋白、血红蛋白、胃泌素、胃动素水平、乳酸杆菌和双歧杆菌菌属数量降低,差异均有统计学意义(t感染组=12.040、9.068、6.620、18.092、20.017、9.276、5.224,t对照组=5.584、4.714、4.001、5.766、10.979、3.265、2.988,P均<0.05),CRP、IL-6、TNF-α、DAO、D-乳酸水平、大肠埃希菌和肠球菌菌属数量升高,差异均有统计学意义(t感染组=53.816、30.694、33.301、21.326、30.518、9.459、7.240,t对照组=27.030、19.616、13.162、10.400、10.716、4.355、4.830,P均<0.05);且感染组手术前后上述指标差值高于对照组,差异均有统计学意义(t=26.407、15.130、10.619、24.409、14.441、22.663、13.359、43.623、23.893、39.153、18.586、24.577、15.025、11.414,P均<0.05)。相关性分析结果显示,术后血清CRP与DAO成正相关(r=0.394,P<0.05);IL-6与白蛋白、血红蛋白、胃泌素、胃动素、乳酸杆菌菌属数量成负相关(r=-0.485、-0.457、-0.427、-0.416、-0.397,P均<0.05),与DAO、D-乳酸、大肠埃希菌和肠球菌菌属数量成正相关(r=0.497、0.451、0.526、0.387,P均<0.05);TNF-α与白蛋白、血红蛋白、胃动素、乳酸杆菌菌属数量成负相关(r=-0.506、-0.469、-0.439、-0.359,P均<0.05),与DAO、D-乳酸、大肠埃希菌和肠球菌菌属数量成正相关(r=0.484、0.426、0.561、0.422,P均<0.05)。结论胃癌患者术后伤口感染会影响机体营养状况和胃肠道功能,同时还会加剧肠道菌群失衡。
Objective To explore the effects of wound infection on nutritional status,gastrointestinal function and intestinal floras in patients after radical resection of gastric cancer.Methods A total of 52 patients with wound infection after radical resection of gastric cancer were enrolled as infection group between January 2018 and December 2021 in Haikou Third People′s Hospital,while 50 patients without infection during the same period were enrolled as control group.The nutritional indexes(albumin,prealbumin,hemoglobin),inflammatory factors[C⁃reactive protein(CRP),interleukin⁃6(IL⁃6),tumor necrosis factorα(TNF⁃α)],gastrointestinal function indexes[gastrin,motilin,diamine oxidase(DAO),D⁃lactic acid]and intestinal floras(Escherichia coli,Lactobacillus,Bifidobacterium,Enterococcus)were compared between the two groups.Results At 3 d after surgery,levels of serum albumin,prealbumin,hemoglobin,gastrin and motilin,counts of Lactobacillus and Bifidobacterium were decreased(tinfection group=12.040,9.068,6.620,18.092,20.017,9.276,5.224,tcontrol group=5.584,4.714,4.001,5.766,10.979,3.265,2.988;all P<0.05),while levels of CRP,IL⁃6,TNF⁃α,DAO and D⁃lactic acid,counts of Escherichia coli and Enterococcus were increased in both groups(tinfection group=53.816,30.694,33.301,21.326,30.518,9.459,7.240,tcontrol group=27.030,19.616,13.162,10.400,10.716,4.355,4.830;all P<0.05).The difference values of the above indexes before and after surgery in infection group were greater than those in control group(t=26.407,15.130,10.619,24.409,14.441,22.663,13.359,43.623,23.893,39.153,18.586,24.577,15.025,11.414;all P<0.05).The results of correlation analysis showed that serum CRP was positively correlated with DAO(r=0.394,P<0.05).IL⁃6 was negatively correlated with albumin,hemoglobin,gastrin,motilin and Lactobacillus count(r=-0.485,-0.457,-0.427,-0.416,-0.397;all P<0.05),while positively correlated with DAO,D⁃lactic acid,counts of Escherichia coli and Enterococcus(r=0.497,0.451,0.526,0.387;all P<0.05).TNF⁃αwas negatively correlated with albumin,hemoglobin,motilin and Lactobacillus count(r=-0.506,-0.469,-0.439,-0.359;all P<0.05).While positively correlated with DAO,D⁃lactic acid,counts of Escherichia coli and Enterococcus(r=0.484,0.426,0.561,0.422;all P<0.05).Conclusion Wound infection affected the nutritional status and gastrointestinal function,and also aggravated the imbalance of intestinal floras in patients with gastric cancer.
作者
吴冲
张小丽
邢益门
周婷
巫翠云
WU Chong;ZHANG Xiaoli;XING Yimen;ZHOU Ting;WU Cuiyun(Department of Gastroenterology,Haikou Third People′s Hospital,Haikou,Hainan 571100,China;Department of Gastroenterology,the First Affiliated Hospital of Hainan Medical College,Haikou,Hainan 570102,China;Department of Laboratory Medicine,Haikou Hospital Affiliated to Xiangya Medical College of Central South University,Haikou,Hainan 570208,China)
出处
《热带医学杂志》
CAS
2024年第2期225-229,245,共6页
Journal of Tropical Medicine
基金
海南省卫生健康行业科研项目(20A200148)。
关键词
胃癌根治术
伤口感染
营养状况
肠道菌群
胃肠功能
Radical resection of gastric cancer
Wound infection
Nutritional status
Intestinal floras
Gastrointestinal function
