Preoperative intestinal dysbacteriosis in colorectal cancer patients and its associated risk factors_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yuwei ¹ , XU Yujie ² ,  LI Ka ² , WANG Ziqiang ¹ , YANG Jie ¹ , JIANG Lili ¹

1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. College of Nursing, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

LI Ka, Email: lika127@126.com

Keywords：

colorectal cancer; intestinal microecology; dysbacteriosis; risk factor

DOI：

10.7507/1007-9424.201905088

Video：

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Objective To investigate the prevalence of preoperative intestinal dysbacteriosis in colorectal cancer patients and its risk factors.Methods From March 2016 to December 2017, patients who received colorectal cancer surgery in the Department of Gastrointestinal Surgery in West China Hospital were prospectively recruited in the study. Fresh fecal samples were collected on the day of admission for gram-stainsmears. The diet, preexisted diseases, medication, and treatment before admission were investigated by a self-designed semi-structured questionnaire.Results Sum to 257 patients were recruited, 123 patients (47.9%) of them had normal intestinal bacterial, 48 patients (18.7%) were in preoperative dysbacteriosis grade Ⅰ, 61 patients (23.7%) were in gradeⅡ, 25 patients (9.7%) were in grade Ⅲ. Orderly logistic regression showed that patients who received antibiotics for 30 days or more per year had a higher risk of preoperative dysbacteriosis than those who did not receive antibiotics (OR=3.38, P=0.025). Patients with BMI≥24.0 kg/m² had a lower risk of dysbacteriosis than patients with BMI<18.5 kg/m² (BMI 24.0～27.9 kg/m², OR=0.36, P=0.030; BMI≥28.0 kg/m², OR=0.23, P=0.032).Conclusion More than half of colorectal cancer patients have intestinal dysbacteriosis prior to surgery, which may be associated with exposure to antibiotics before admission and low BMI.

Citation： LIU Yuwei, XU Yujie, LI Ka, WANG Ziqiang, YANG Jie, JIANG Lili. Preoperative intestinal dysbacteriosis in colorectal cancer patients and its associated risk factors. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(10): 1189-1195. doi: 10.7507/1007-9424.201905088 Copy

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2.	中华预防医学会微生态学分会. 中国消化道微生态调节剂临床应用专家共识 (2016版). 中华临床感染病杂志, 2016, 9(3): 193-206.
3.	Liu Z, Qin H, Yang Z, et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery–a double-blind study. Aliment Pharmacol Ther, 2011, 33(1): 50-63.
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7.	张秀荣. 肠道菌群粪便涂片检查图谱. 北京: 人民军医出版社, 2000: 4-5.
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9.	刘启辰, 李丹, 曾小芳, 等. 重庆市居民体力活动、静坐及睡眠时间对高血压患病率的影响. 西安交通大学学报: 医学版, 2019, 40(3): 474-479.
10.	曾忠铭, 潘令嘉, 周殿元, 等. 临床微生态学及其理论基础. 中国微生态学杂志, 1999, 11(6): 321-328.
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13.	马鹏程. 肠道菌群失调与结直肠癌上皮间充质转化的相关性研究. 石家庄: 河北医科大学, 2017.
14.	闫志辉, 崔立红, 浦江, 等. 结直肠癌及肠道腺瘤性息肉患者肠道菌群失调情况及相关危险因素分析. 解放军医药杂志, 2017, 29(5): 25-29.
15.	熊德鑫. 肠道微生态制剂与消化道疾病的防治. 北京: 科学出版社, 2008: 20-21.
16.	Ahn J, Sinha R, Pei Z, et al. Human gut microbiome and risk for colorectal cancer. J Natl Cancer Inst, 2013, 105(24): 1907-1911.
17.	郭世奎, 包维民, 龚昆梅, 等. SYBR GreenⅠ实时荧光定量PCR法分析结直肠癌患者肠道菌群变化. 中国普外基础与临床杂志, 2010, 17(5): 463-468.
18.	吴承堂, 谭建美. 大肠癌术后肠道菌群变化的临床研究. 中华普通外科杂志, 2004, 19(6): 334-336.
19.	Rodríguez-Varón A, Muñoz OM, Pulido-Arenas J, et al. Antibiotic-associated diarrhea: clinical characteristics and the presence of Clostridium difficile. Rev Gastroenterol Mex, 2017, 82(2): 129-133.
20.	Yoon MY, Yoon SS. Disruption of the gut ecosystem by antibiotics. Yonsei Med J, 2018, 59(1): 4-12.
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22.	Korpela K, Salonen A, Virta LJ, et al. Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children. Nat Commun, 2016, 7: 10410.
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24.	张悦, 林娴婷, 何贵蓉. 华东两市城市与农村老年居民抗生素知识水平与自我用药行为差异性分析. 护理研究, 2019, 33(4): 667-670.
25.	Wang H, Wang B, Zhao Q, et al. Antibiotic body burden of Chinese school children: a multisite biomonitoring-based study. Environ Sci Technol, 2015, 49(8): 5070-5079.
26.	de La Serre CB, Ellis CL, Lee J, et al. Propensity to high-fat diet-induced obesity in rats is associated with changes in the gut microbiota and gut inflammation. Am J Physiol Gastrointest Liver Physiol, 2010, 299(2): G440-G448.
27.	Van Immerseel F, Ducatelle R, De Vos M, et al. Butyric acid-producing anaerobic bacteria as a novel probiotic treatment approach for inflammatory bowel disease. J Med Microbiol, 2010, 59(Pt 2): 141-143.
28.	Stringer AM, Gibson RJ, Logan RM, et al. Gastrointestinal microflora and mucins may play a critical role in the development of 5-Fluorouracil-induced gastrointestinal mucositis. Exp Biol Med (Maywood), 2009, 234(4): 430-441.
29.	Shimizu K, Ogura H, Tomono K, et al. Patterns of Gram-stained fecal flora as a quick diagnostic marker in patients with severe SIRS. Dig Dis Sci, 2011, 56(6): 1782-1788.

1. 康白. 正常微生物群是一个新的人体生理学系统. 中国微生态学杂志, 2003, 15(2): 4-6.
2. 中华预防医学会微生态学分会. 中国消化道微生态调节剂临床应用专家共识 (2016版). 中华临床感染病杂志, 2016, 9(3): 193-206.
3. Liu Z, Qin H, Yang Z, et al. Randomised clinical trial: the effects of perioperative probiotic treatment on barrier function and post-operative infectious complications in colorectal cancer surgery–a double-blind study. Aliment Pharmacol Ther, 2011, 33(1): 50-63.
4. Vaishnavi C. Translocation of gut flora and its role in sepsis. Indian J Med Microbiol, 2013, 31(4): 334-342.
5. Shogan BD, Belogortseva N, Luong PM, et al. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med, 2015, 7(286): 286ra68.
6. Iida N, Dzutsev A, Stewart CA, et al. Commensal bacteria control cancer response to therapy by modulating the tumor microenvironment. Science, 2013, 342(6161): 967-970.
7. 张秀荣. 肠道菌群粪便涂片检查图谱. 北京: 人民军医出版社, 2000: 4-5.
8. Ainsworth BE, Haskell WL, Herrmann SD, et al. 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc, 2011, 43(8): 1575-1581.
9. 刘启辰, 李丹, 曾小芳, 等. 重庆市居民体力活动、静坐及睡眠时间对高血压患病率的影响. 西安交通大学学报: 医学版, 2019, 40(3): 474-479.
10. 曾忠铭, 潘令嘉, 周殿元, 等. 临床微生态学及其理论基础. 中国微生态学杂志, 1999, 11(6): 321-328.
11. Velasquez-Manoff M. Gut microbiome: the peacekeepers. Nature, 2015, 518(7540): S3-S11.
12. Guyton K, Alverdy JC. The gut microbiota and gastrointestinal surgery. Nat Rev Gastroenterol Hepatol, 2017, 14(1): 43-54.
13. 马鹏程. 肠道菌群失调与结直肠癌上皮间充质转化的相关性研究. 石家庄: 河北医科大学, 2017.
14. 闫志辉, 崔立红, 浦江, 等. 结直肠癌及肠道腺瘤性息肉患者肠道菌群失调情况及相关危险因素分析. 解放军医药杂志, 2017, 29(5): 25-29.
15. 熊德鑫. 肠道微生态制剂与消化道疾病的防治. 北京: 科学出版社, 2008: 20-21.
16. Ahn J, Sinha R, Pei Z, et al. Human gut microbiome and risk for colorectal cancer. J Natl Cancer Inst, 2013, 105(24): 1907-1911.
17. 郭世奎, 包维民, 龚昆梅, 等. SYBR GreenⅠ实时荧光定量PCR法分析结直肠癌患者肠道菌群变化. 中国普外基础与临床杂志, 2010, 17(5): 463-468.
18. 吴承堂, 谭建美. 大肠癌术后肠道菌群变化的临床研究. 中华普通外科杂志, 2004, 19(6): 334-336.
19. Rodríguez-Varón A, Muñoz OM, Pulido-Arenas J, et al. Antibiotic-associated diarrhea: clinical characteristics and the presence of Clostridium difficile. Rev Gastroenterol Mex, 2017, 82(2): 129-133.
20. Yoon MY, Yoon SS. Disruption of the gut ecosystem by antibiotics. Yonsei Med J, 2018, 59(1): 4-12.
21. Tamma PD, Avdic E, Li DX, et al. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med, 2017, 177(9): 1308-1315.
22. Korpela K, Salonen A, Virta LJ, et al. Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children. Nat Commun, 2016, 7: 10410.
23. 李文旋, 李小英, 宁丽娜, 等. 甘肃省老年人抗生素认知与自我用药行为调查. 中国老年学杂志, 2015, 35(24): 7180-7182.
24. 张悦, 林娴婷, 何贵蓉. 华东两市城市与农村老年居民抗生素知识水平与自我用药行为差异性分析. 护理研究, 2019, 33(4): 667-670.
25. Wang H, Wang B, Zhao Q, et al. Antibiotic body burden of Chinese school children: a multisite biomonitoring-based study. Environ Sci Technol, 2015, 49(8): 5070-5079.
26. de La Serre CB, Ellis CL, Lee J, et al. Propensity to high-fat diet-induced obesity in rats is associated with changes in the gut microbiota and gut inflammation. Am J Physiol Gastrointest Liver Physiol, 2010, 299(2): G440-G448.
27. Van Immerseel F, Ducatelle R, De Vos M, et al. Butyric acid-producing anaerobic bacteria as a novel probiotic treatment approach for inflammatory bowel disease. J Med Microbiol, 2010, 59(Pt 2): 141-143.
28. Stringer AM, Gibson RJ, Logan RM, et al. Gastrointestinal microflora and mucins may play a critical role in the development of 5-Fluorouracil-induced gastrointestinal mucositis. Exp Biol Med (Maywood), 2009, 234(4): 430-441.
29. Shimizu K, Ogura H, Tomono K, et al. Patterns of Gram-stained fecal flora as a quick diagnostic marker in patients with severe SIRS. Dig Dis Sci, 2011, 56(6): 1782-1788.

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Preoperative intestinal dysbacteriosis in colorectal cancer patients and its associated risk factors

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