补充微生态制剂对腰椎后路手术患者肠道菌群失调的影响

目的探讨微生态制剂金双歧对腰椎后路手术患者肠道菌群的影响。方法72例腰椎后路手术患者，出现肠道菌群失调症者42例作为实验组（A组），未出现肠道菌群失调症的30例作为对照组（B组）。两组患者术前、术后检测血浆内毒素、血清肿瘤坏死因子or．（TNF—a）及白细胞介素6（IL-6）。肠道菌群失调症者术后另加用金双歧。术前、术后第1次自然排便（术后1—4d）时分别留取粪便标本，比较两组患者肠道主要菌群差异、双歧杆菌（B）／肠杆菌（E）值。结果术前、术后第2、7天A、B两组患者血浆内毒素水平分别为（1．82±0．12）、（2．29±0．15）、（1．91±0．08）ng／L和（1．91±0．21）、（2．35±0．16）、（2．26±0．24）ng／L。TNF—d分另0为（275±51）、（309±45）、（276士34）ng／I~和（269±48）、（318±67）、（297±53）ng／L；IL-6分另0为（1384-22）、（159±15）、（137±17）ng／L和（159±16）、（187±19）、（174±21）ng／L。经重复测量方差分析显示，血浆内毒素、TNF-a、IL-63个指标组间、交互作用差异均有统计学意义（P均〈0．05），组内比较差异无统计学意义（P均〉0．05）。3个指标浓度均随着住院时间的延长而逐渐降低，术后第2、7天与术前比较差异均有统计学意义（P均〈0．05），且术后第7天与术后第2天比较差异也有统计学意义（P均〈0．05）。术后第2天A组血浆内毒素、TNF．仪、IL-6与B组比较差异均有统计学意义（P均〈0．05）；术后第7天，A组内毒素、TNF-仪、IL-6开始缓慢下降，与B组比较差异均有统计学意义（P均〈0．05）。术后A组肠道的双歧杆菌、类杆菌数量及B／E值较B组均减少，分别为（9．17±0．54）lgefu／g与（10．01±0．75）lgcfu／g，（9．23±0．47）lgcfu／g与（10．09±0．81）lgcfu／g，1．01±0．16与1．20-1-0．11，差异均有统计学意义（P值分别为0．031、0．042、0．029）；而肠杆菌、肠球菌数量较B组增加，分别为（9．11±1．02）lgcfu／g与（8．81±0．89）lgcfu／g，（7．80±1．02）lgefu／g与（7．29±0．98）lgcfu／g，差异均有统计学意义（P值分别为0．037、0．043）；小梭菌、乳杆菌与B组比较差异均无统计学意义（P均〉0．05）。A组使用金双歧后与使用前比较均增加，差异均有统计学意义[双歧杆菌：（13．叭±0．87）lgcfu／g与（9．17±0．54）lgefu／g、类杆菌数量：（14．12±0．75）lgcfu／g与（9．23±0．47）lgcfu／g及B／E值：1．28±0．45与1．01±0．16，P值分别为0．045、0．034、0．038]；肠杆菌、肠球菌、小梭菌、乳杆菌数量无明显变化，分别为（8．71±0．91）Igcfu／g与（9．11±1．02）lgcfu／g，（7．01±0．54）lgcfu／g与（7．80±1．02）lgcfu／g，（5．23±1．04）lgcfu／g与（5．15±0．89）lgcfu／g，（6．71±1.04）lgcfu／g与（6．53±0．86）lgcfu／g，差异均无统计学意义（P均〉0．05）。结论腰椎后路手术出现肠道菌群失调的患者常合并内毒素血症及炎症反应，肠道内双歧杆菌、类杆菌数量减少，肠杆菌、肠球菌等条件致病菌数量相对增加，肠道微生物定植抗力下降。补充微生态制剂金双歧能缓解机体的内毒素血症及炎症反应，改善腰椎后路手术后肠道菌群失调，有利于术后重建肠道内微生态的平衡。

Effect of micro-ecological agent on the intestinal dysbacteriosis of patients with posterior lumbar spinesurgery

Objective To investigate the effect of micro-ecological agent on the intestinal flora of patients with posterior lumbar spine surgery. Methods Seventy-two patients with lumbar spine surgery were selected as our subjects. Of them, 42 patients with occurred the intestinal flora dysfunction were served as experimental group （group A）, other 30 patients were as control group （group B ）. The levels of plasma endotoxin,plasma tumor necrosis factor-o~ （TNF-ct）, Interleukin 6 （IL-6） were detected before and after operation. The patients in group A were treated with micro-ecological agent Jinshuangqi. Collected stool samples at preoperative, postoperative first natural defecation （after 1 -4 d）, and compared intestinal flora difference and Bifidobacterium （B）/Enterobacteriaceae （E） value of two groups patients. Results The levels of plasma endotoxin in group A were （ 1.82±0. 12）, （2. 29 ＋0. 15）, （ 1.91±0.08） ng/L at before surgery,the 2nd and 7th day after surgery, and that in group B were （ 1.91 ± O. 21 ）, （2. 35 ± 0. 16 ）, （2. 26 ± 0. 24） ng/L. The TNF- a level in group A were （275 _＋51） ,（309 _＋45） ,（276 ±34） ng/L and that in group B were （269±48） ,（318 ±67）, （297 ±53） ng/L at before surgery,the 2nd and 7th day after surgery. The IL-6 levels in group A were （ 138 ＋ 22 ）, （ 159 ± 15 ）, （ 137 ± 17 ） ng/L and that in group B were （ 159± 16 ）, （ 187 ± 19 ）, （ 174 ± 21 ） ng/L at before surgery, the 2nd and 7th day after surgery. The repeated measured repeated measures analysis of variance showed that among three indexes of plasma endotoxin, TNF-ot, IL-6 levels, differences of between group and interaction were statistically significant （ P 〈 0.05 ）, but there was no significant difference within groups （ P 〉 0. 05 ）. The levels of plasma endotoxin, TNF-a, IL-6 decreased after surgery ware gradually decreasing with hospitalization prolonged. There was significant difference between before surgery and at the 2nd,7th day after surgery（P 〈 0.05）, and there was significant difference between the 2nd and the 7th day after surgery（P 〈 0.05 ）. At the 2nd day after surgery, there was significant difference between group A and group B in terms of the level of plasma endotoxin, TNF-a, IL-6. At the 7th day, the levels of plasma endotoxin, TNF-ot, IL-6 were slowly decreased in group A, and there were significant difference compared to group B （ P 〈 0. 05 ）. The numbers of intestinal Bifidobaeterium, Baeteroides, and B/E values of group A were decreased after surgery compared to group B（（9. 17 ±0.54） lg cfu/g vs. （10.01 ±0.75） lg efu/g, （9.23±0.47） lg cfu/g vs. （10.09 ±.81） lg cfu/g, （ 1.01± 0. 16 ） vs. （ 1.20 ± 0. 11 ） ）, and the difference was significant （ P = 0. 031,0. 042, O. 029 respectively）. The levels of Enterobacter and Enteroeoccus in group A were （ 9. 11 ± 1.02 ） ig cfu/g, （ 7. 80 ± 1.02） lg efufg, higher than that of group B （ （ 8.81± O. 89） lg efu/g, （7.29 ± 0. 98 ） lg efu/g （ P = 0. 037, 0. 043 ） ）. There was no significant difference between two groups in terms of small clostridium and lactobacillus （P 〉 0. 05 ）. After treated with micro-ecological agent Jinshuangqi, the levels of intestinal Bifidobacterium, Baeteroides, and B/E value at was increased compared to before treated in group A （Bifidobacterium： （13.01 ± O. 87 ） lg cfu/g vs. （ 9. 17± O. 54 ） lg cfu/g; Bacteroides ： （ 14. 12 ± 0. 75 ） lg cfu/g vs. （ 9. 23 ± 0.47 ） lg cfufg; B/E value ： （ 1.28 ± O. 45 ） vs. （ 1.01 ± 0. 16 ） ; P = 0. 045,0. 034,0. 038 respectively ）. No significant difference was seen in terms of the levels of Enterobacter, Enteroeoccus, small clostridium and lactobacillus between two groups （8. 71± O. 91 ） lg efu/g vs. （ 9. 11± 1.02 ） lg cfu/g, （ 7. 01 ± 0. 54 ） lg cfu/g vs. （ 7.80 ±1.02） lg cfu/g,（5. 23 ± 1.04） lg cfu/g vs. （5.15 ±0.89） lg cfufg, （6. 71 ±1.04） lg cfu/g vs. （6.53 ± 0. 86） lg cfu/g respectively; P 〉 0.05 ）. Conclusion Posterior lumbar operation patients with intestinal dysbacteriosis often associated with endotoxemia and inflammatory reaction, the levels of bifidobaeteria, Bacteroides intestinal Enterobacteriaceae decrease while Enterococcus, opportunistic pathogens increase, and intestinal microbial colonization resistance decrease. Micro-ecological agent Jinshuangqi treatment can ease the body＇s endotoxemia and inflammatory response, improved lumbar surgery intestinal flora after surgery, and beneficial to rebuild the intestinal mieroflora balance.