结直肠癌根治术后肠道菌群、miR-10a表达变化及微生态肠内营养干预作用

背景直肠癌根治术为治疗直肠癌的重要方法,但手术引起的肠道菌群失调、基因表达变化均不利于预后改善,积极探索术后肠道菌群、相关基因表达变化情况对指导干预措施的制定具有重要指导价值.目的探讨结直肠癌根治术后肠道菌群、微小RNA-10a(microRNA-10a,miR-10a)表达变化情况,并分析微生态肠内营养干预的作用.方法选取2017-07/2020-06期间我院107例结直肠癌根治术患者作为研究对象,比较不同肠道菌群情况患者肠道菌群、miR-10a表达变化,分析肠道菌群、miR-10a表达与肠道菌群失调的关系,并对肠道菌群紊乱患者进行微生态肠内营养干预,对比干预前后患者肠道菌群、miR-10a表达,比较不同疗效患者临床资料、肠道菌群、miR-10a表达,分析微生态肠内营养干预疗效影响因素,及肠道菌群、miR-10a表达对微生态肠内营养干预疗效的评估价值,并分析肠道菌群失调患者肠道菌群与miR-10a表达的相关性.结果结直肠癌根治术后菌群正常患者乳酸杆菌、双歧杆菌、真杆菌菌群菌落数、miR-10a表达均高于菌群失调Ⅰ度、Ⅱ度患者,菌群失调Ⅰ度患者高于菌群失调Ⅱ度患者,肠球菌均低于菌群失调Ⅰ度、Ⅱ度患者,菌群失调Ⅰ度患者低于菌群失调Ⅱ度患者(P<0.05);随着乳酸杆菌、双歧杆菌、真杆菌菌群菌落数、miR-10a表达降低、肠球菌菌群菌落数升高,结直肠癌根治术后肠道菌群失调发生风险升高(P<0.05);肠道菌群紊乱患者微生态肠内营养干预后乳杆菌、双歧杆菌、真杆菌菌群菌落数及miR-10a均高于干预前,肠球菌菌群菌落数低于干预前(P<0.05);年龄、DUKE分期、干预后乳酸杆菌、双歧杆菌、肠球菌及真杆菌菌群菌落数、miR-10a表达均与微生态肠内营养干预疗效显著相关(P<0.05);干预后肠道菌群、miR-10a表达评估微生态肠内营养干预效果的曲线下面积(AUC)均>0.70.结论结直肠癌根治术后肠道菌群、miR-10a表达变化与肠道菌群失调的发生显著相关,给予微生态肠内营养干预可有效调节肠道菌群、miR-10a表达,且肠道菌群、miR-10a表达可作为评估干预效果的指标.

Changes of intestinal flora and miR-10a expression after radical resection of colorectal cancer:Effect of microecological enteral nutrition intervention

BACKGROUND Radical resection is an important method for the treatment of rectal cancer,but the imbalance of intestinal flora and changes in gene expression caused by surgery are not conducive to the improvement of prognosis.It is of great value to explore the changes of intestinal flora and related gene expression after surgery for the formulation of intervention measures.AIM To investigate the changes in intestinal flora and microRNA-10a(miR-10a)expression after radical resection of colorectal cancer,and to analyze the effect of microecological enteral nutrition intervention.METHODS From July 2017 to June 2020,107 patients with colorectal cancer undergoing radical resection at our hospital were selected as research subjects.The intestinal flora and miR-10a expression changes of patients with different intestinal flora were compared,and the relationship between the intestinal flora,miR-10a expression,and dysbacteriosis was analyzed.Microecological enteral nutrition intervention was carried out for patients with intestinal flora disorders,and the intestinal flora and miR-10a expression of patients before and after the intervention were compared.Clinical data,intestinal flora,and miR-10a expression of patients with different curative effects were compared.Factors affecting the efficacy of microecological enteral nutrition intervention were analyzed,as well as the value of intestinal flora and miR-10a expression in evaluation of efficacy of microecological enteral nutrition intervention.The correlation between the intestinal flora and the expression of miR-10a in patients with dysbacteriosis was analyzed.RESULTS The numbers of colonies of Lactobacillus,Bifidobacterium,and Eubacterium,and miR-10a expression were higher in patients with normal flora after radical resection of colorectal cancer than those in patients with dysbacteriosis degreesⅠandⅡ,and in patients with dysbacteriosis degreeⅠthan in those with dysbacteriosis degreeⅡ.The number of Enterococcus was lower in patients with normal flora after radical resection of colorectal cancer than in those with dysbacteriosis degreesⅠandⅡ,and in patients with dysbacteriosis degreeⅠthan in those with dysbacteriosis degreeⅡ(P<0.05).As the numbers of Lactobacillus,Bifidobacterium,and Eubacterium,and the expression of miR-10a decreased,and the number of Enterococcus increased,the risk of dysbacteriosis in patients after radical resection of colorectal cancer increased(P<0.05).The numbers of Lactobacillus,Bifidobacterium,and Eubacterium and miR-10a expression were higher and the number of Enterococcus was lower in patients after microecological enteral nutrition intervention than in patients before intervention(P<0.05).Age,Duke stage,numbers of Lactobacillus,Bifidobacterium,Enterococcus and Eubacterium after intervention,and miR-10a expression were all significantly correlated with the efficacy of microecological enteral nutrition intervention(P<0.05).After intervention,the areas under the curves of the intestinal flora and miR-10a expression in evaluating the efficacy of microecological enteral nutrition intervention were both>0.7.CONCLUSION The intestinal flora and miR-10a expression changes after radical resection of colorectal cancer are significantly related to the occurrence of dysbacteriosis.Microecological enteral nutrition intervention can effectively regulate the intestinal flora and miR-10a expression,and the intestinal flora and miR-10a expression can be used as indicators to evaluate the intervention efficacy.