肠道菌群失调、炎症因子变化、维生素缺乏与肝癌患者根治术后复发的关系
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摘要
目的:观察肝癌根治术后患者肠道菌群失调、炎症因子水平及维生素水平,分析其与术后复发的相关性。方法:选取2015年6月至2017年6月于我院行肝癌根治术患者120例,随访1年后,按照复发情况分为复发组和无复发组,测定两组患者的肠道菌群情况、炎症因子和维生素水平,采用Pearman相关性分析法对肠道细菌总负荷、炎症因子、维生素水平与AFP的相关性进行分析,P<0.05为差异有统计学意义。结果:复发组和无复发组在年龄、性别、基础肝脏疾病、肝功能分级、手术切除方式、术中肝门是否阻断、肿瘤最大直径及术后是否化疗等方面差异无统计学意义;复发组的炎症因子(PCT、CRP、IL-6)水平明显高于无复发组(P<0.05);复发组的AFP、AKP、ALT水平明显高于无复发组(P<0.05);复发组的维生素水平(25-羟维生素D_3、维生素B_(12)及维生素C)明显低于无复发组(P<0.05);复发组的细菌总负荷明显高于无复发组,其中双歧杆菌和乳酸杆菌两种益生菌菌种水平明显低于无复发组;细菌总负荷(r=0.792,P<0.001)、CRP(r=0.724,P<0.001)与AFP呈正相关,维生素C水平(r=-0.663,P<0.001)与AFP呈负相关。结论:肝癌术后是否复发与肠道菌群失调、炎症因子变化及维生素缺乏有着密切的关系。
Objective:To analyze the relationship between recurrence of liver cancer after radical resection and postoperative flora dissonance,inflammatory factor level and vitamin deficiency.Methods:120 patients were selected after radical resection of liver cancer in our hospital from June 2015 to June 2017.After one year of follow-up,recurrence was divided into recurrence group and non-recurrence group.Intestinal flora,inflammatory factors,liver function,and vitamin levels were measured in both groups.The correlation between total intestinal bacterial load,inflammatory factors,vitamin levels and AFP was analyzed by pearman correlation analysis.Results:The levels of inflammatory factors(PCT,CRP,IL-6),AFP,ALT and AKP were significantly higher in the relapse group than in the non-recurrence group(P<0.05).The vitamin levels of the relapse group(25-hydroxyvitamin D_3,vitamin B_(12) and vitamin C) were significantly lower than those of the non-recurrence group(P<0.05).The total bacterial load of the recurrent group was significantly higher than that of the non-recurrent group,and the level of two probiotics,bifidobacterium and lactobacillus,was significantly lower than that of the non-recurrent group.Total bacterial load(r=0.792,P<0.001) and CRP(r=0.724,P<0.001) were positively correlated with AFP,while vitamin C level(r=-0.663,P<0.001) was negatively correlated with AFP.Conclusion:The recurrence of liver cancer after operation is closely related to the imbalance of intestinal flora,changes of inflammatory factors and vitamin deficiency.
Objective:To analyze the relationship between recurrence of liver cancer after radical resection and postoperative flora dissonance,inflammatory factor level and vitamin deficiency.Methods:120 patients were selected after radical resection of liver cancer in our hospital from June 2015 to June 2017.After one year of follow-up,recurrence was divided into recurrence group and non-recurrence group.Intestinal flora,inflammatory factors,liver function,and vitamin levels were measured in both groups.The correlation between total intestinal bacterial load,inflammatory factors,vitamin levels and AFP was analyzed by pearman correlation analysis.Results:The levels of inflammatory factors(PCT,CRP,IL-6),AFP,ALT and AKP were significantly higher in the relapse group than in the non-recurrence group(P<0.05).The vitamin levels of the relapse group(25-hydroxyvitamin D_3,vitamin B_(12) and vitamin C) were significantly lower than those of the non-recurrence group(P<0.05).The total bacterial load of the recurrent group was significantly higher than that of the non-recurrent group,and the level of two probiotics,bifidobacterium and lactobacillus,was significantly lower than that of the non-recurrent group.Total bacterial load(r=0.792,P<0.001) and CRP(r=0.724,P<0.001) were positively correlated with AFP,while vitamin C level(r=-0.663,P<0.001) was negatively correlated with AFP.Conclusion:The recurrence of liver cancer after operation is closely related to the imbalance of intestinal flora,changes of inflammatory factors and vitamin deficiency.
引文
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[18] YAO XW.Clinical value of abdominal ultrasound,CT combined with serum alpha-fetoprotein in diagnosis of primary liver cancer[J].Modern Oncology,2018,26(22):3606-3608.[姚相巍.腹部超声、CT联合血清甲胎蛋白诊断原发性肝癌的临床价值[J].现代肿瘤医学,2018,26(22):3606-3608.]
[2] Kanazawa A,Tsukamoto T,Shimizu S.Laparoscopic hepatectomy for liver cancer[J].Dig Dis,2015,33(5):691-698.
[3] Xiang L,Xiao L,Li J.Safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma in the posterosuperior liver segments[J].World J Surg,2015,39(5):1202-1209.
[4] Grat M,Wronka KM,Krasnodebski M.Profile of gut microbiota associated with the presence of hepatocellular cancer in patients with liver cirrhosis[J].Transplant Proc,2016,48(5):1687-1691.
[5] Sepideh A,Karim P,Hossein A.Effects of multi-strain probiotic supplementation on glycemic and inflammatory indices in patients with nonalcoholic fatty liver disease:A doubleblind randomized clinical trial[J].J Am Coll Nutr,2016,35(6):500-505.
[6] CHEN XP,ZHANG WG.Innovation and development of hepatectomy technology[J].Chinese Journal of General Surgical Surgery,2017,11(05):361-363.[陈孝平,张万广.肝癌切除技术创新与发展[J].中华普外科手术学杂志,2017,11(05):361-363.]
[7] WANG QR,HU CD,WU L,et al.Risk factors for recurrence of primary hepatocellular carcinoma after resection[J].The Journal of Difficult and Difficult Diseases,2018,17(07):706-709.[王清睿,胡赤丁,吴琳,等.原发性肝细胞癌切除术后复发的危险因素分析[J].疑难病杂志,2018,17(07):706-709.]
[8] Sun L,Dai JJ,Hu WF.Expression of toll-like receptors in hepatic cirrhosis and hepatocellular carcinoma[J].Genet Mol Res,2016,15(2):419.
[9] Xu D,Huang Y,Wang J.Gut microbiota modulate the immune effect against hepatitis B virus infection[J].European J Clin Microbiol Infect Dis,2015,34(11):2139-2147.
[10] Bhat M,Arendt BM,Bhat V.Implication of the intes tinal microbiome in complications of cirrhosis[J].World J Hepatol,2016,8(27):1128-1136.
[11] Tao X,Wang N,Qin W.Gut microbiota and hepatocellular carcinoma[J].Gastrointest Tumors,2015,2(1):33-40.
[12] Brandi G,DE Lorenzo S,Candela M.Microbiota,NASH,HCC and the potential role of probiotics[J].Carcinogenesis,2017,38(3):231-240.
[13] Yao J,Chang L,Yuan L.Nutrition status and small in testinalbacterial overgrowth in patients with virus-related cirrhosis[J].Asia Pac J Clin Nutr,2016,25(2):283-291.
[14] Liu Y,Li T,Xu Y.Effects of TLR4 gene silencing on the proliferation and apotosis of hepatocarcinoma HEPG2 cells[J].Oncol Lett,2016,11(5):3054-3060.
[15] Marlicz W,Wunsch E,Mydlowska M.The effect of short term treatment with probiotic VSL 3 on various clinical and biochemical parameters in patients with liver cirrhosis[J].Physiol Pharmacol,2016,67(6):867-877.
[16] Large cohort studies in Japan have shown that elevated circulating vitamin D levels reduce systemic and liver specific tumor risk[J].Journal of Applied Oncology,2018,32(02):183.[日本大型队列研究证实循环维生素D浓度升高可降低全身以及肝特异性肿瘤风险[J].实用肿瘤学杂志,2018,32(02):183.]
[17] ZHANG YX,CHEN H,XIONG YQ,et al.Research progress of vitamin D3 and gastrointestinal cancer[J].Oncology Metabolism and Nutrition Electronic Journal of Cancer Metabolism and Nutrition,2017,4(04):472-476.[张永欣,陈浩,熊永强,等.维生素D3与胃肠道肿瘤的研究进展[J].肿瘤代谢与营养电子杂志,2017,4(04):472-476.]
[18] YAO XW.Clinical value of abdominal ultrasound,CT combined with serum alpha-fetoprotein in diagnosis of primary liver cancer[J].Modern Oncology,2018,26(22):3606-3608.[姚相巍.腹部超声、CT联合血清甲胎蛋白诊断原发性肝癌的临床价值[J].现代肿瘤医学,2018,26(22):3606-3608.]
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