慢性传输型便秘患者肠道微生态特点及结肠次全切除术效果分析
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摘要
目的探讨慢性传输型便秘(STC)患者肠道微生态特点及结肠次全切除术的临床疗效。方法选择2015年1月至2017年1月在新乡医学院第一附属医院接受结肠次全切除术治疗的STC患者28例为观察组,另选择体检健康者26例为对照组。留取2组受试者粪便标本,一部分标本通过选择性培养基对乳酸杆菌、双歧杆菌、类杆菌、肠杆菌、肠球菌、梭杆菌进行分离培养和计数,计算各种菌的丰度;另一部分标本提取粪便微生物总DNA,通过末端限制性片段长度多态性分析粪便中细菌多样性和丰富度。采用Wexner便秘评分标准和胃肠动力学检查系统对观察组患者手术前后排便功能进行评估。结果观察组患者肠道细菌香农多样性指数和丰富度均显著低于对照组(P<0.05)。观察组患者肠道中乳酸杆菌、双歧杆菌及类杆菌的丰度显著低于对照组,肠杆菌、肠球菌及梭杆菌的丰度显著高于对照组(P<0.05)。观察组患者术后3个月Wexner便秘评分低于术前,肛管高压带、静息压、最大收缩压和收缩持续时间均高于术前(P<0.05)。结论 STC患者存在结肠菌群紊乱,而结肠次全切除术可有效改善患者的便秘症状。
Objective To explore the characteristics of intestinal microecology and the effect of subtotal colectomy in patients with slow transit constipation( STC). Methods Twenty-eight STC patients who underwent subtotal colectomy in the First Affiliated Hospital of Xinxiang Medical University from January 2015 to January 2017 were selected as observation group.At the same time,twenty-six healthy people were selected as control group. The stool specimen of subjects in the two groups were collected; a part of stool specimen was used to isolate and culture the Lactobacilli,Bifidobacteria,Bacteriod,Enterobacteria,Enterococcus,Clostridium; the other part of stool specimen was used to extract the total DNA of fecal microorganism,and the bacteria diversity and richness of stool specimen was tested by terminal restriction fragment length polymorphism. The defecation function of patients in observation group was evaluated by Wexner constipation score standard and gastrointestinal dynamic examination system before and after operation. Results The Shannon' s diversity index and richness of intestinal bacteria of subjects in observation group were significantly lower than those in the control group( P < 0. 05). The number of Lactobacilli,Bifidobacteria,Bacteriod in intestinal tract of subjects in observation group was significantly lower than that in the control group( P < 0. 05); the number of Enterobacteria,Enterococcus,Clostridium in intestinal tract of subjects in observation group was significantly higher than that in the control group( P < 0. 05). The Wexner constipation score of subjects in observation at three months after operation was significantly lower than that before operation( P < 0. 05); the anal canal high pressure band,resting pressure,maximum systolic pressure and contraction duration of subjects in observation at three months after operation was significantly lower than that before operation( P < 0. 05). Conclusion STC patients have the imbalance of microbial in colon.The subtotal colectomy can effectively improve the symptoms of constipation.
Objective To explore the characteristics of intestinal microecology and the effect of subtotal colectomy in patients with slow transit constipation( STC). Methods Twenty-eight STC patients who underwent subtotal colectomy in the First Affiliated Hospital of Xinxiang Medical University from January 2015 to January 2017 were selected as observation group.At the same time,twenty-six healthy people were selected as control group. The stool specimen of subjects in the two groups were collected; a part of stool specimen was used to isolate and culture the Lactobacilli,Bifidobacteria,Bacteriod,Enterobacteria,Enterococcus,Clostridium; the other part of stool specimen was used to extract the total DNA of fecal microorganism,and the bacteria diversity and richness of stool specimen was tested by terminal restriction fragment length polymorphism. The defecation function of patients in observation group was evaluated by Wexner constipation score standard and gastrointestinal dynamic examination system before and after operation. Results The Shannon' s diversity index and richness of intestinal bacteria of subjects in observation group were significantly lower than those in the control group( P < 0. 05). The number of Lactobacilli,Bifidobacteria,Bacteriod in intestinal tract of subjects in observation group was significantly lower than that in the control group( P < 0. 05); the number of Enterobacteria,Enterococcus,Clostridium in intestinal tract of subjects in observation group was significantly higher than that in the control group( P < 0. 05). The Wexner constipation score of subjects in observation at three months after operation was significantly lower than that before operation( P < 0. 05); the anal canal high pressure band,resting pressure,maximum systolic pressure and contraction duration of subjects in observation at three months after operation was significantly lower than that before operation( P < 0. 05). Conclusion STC patients have the imbalance of microbial in colon.The subtotal colectomy can effectively improve the symptoms of constipation.
引文
[1]中华医学会消化病学分会胃肠动力学组,中华医学会外科学分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013年,武汉)[J].中华消化杂志,2013,33(12):291-297.
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[9]CLEMENTE J C,URSELL L K,PARFREY L W.The impact of the gut microbiota on human health:an integrative view[J].Cell,2012,148(6):1258-1270.
[10]CHOI C H,CHANG S K.Alteration of gut microbiota and efficacy of probiotics in functional constipation[J].J Neurogastroenterol Motil,2015,21(1):4-7.
[11]王中心,吕永庭.经腹腔镜和开腹结肠次全切除术治疗结肠慢传输性便秘的比较[J].武汉大学学报(医学版),2011,32(1):123-124,135.
[2]吴本升,陈玉根.慢性传输性便秘病理基础研究[J].长春中医药大学学报,2012,28(5):824-825.
[3]DROSSMAN D A.The functional gastrointestinal disorders and the RomeⅢprocess[J].Gastroenterology,2006,130(5):1377-1390.
[4]DESAI C,MADAMWAR D.Extraction of inhibitor-free metagenomic DNA from polluted sediments,compatible with molecular diversity analysis using adsorption and ion-exchange treatments[J].Bioresour Technol,2006,98(4):761-768.
[5]王林,姜军,丁威威,等.顽固性便秘病人结肠黏膜菌群的变化特征[J].肠外与肠内营养,2014,21(1):12-15.
[6]AGACHAN F,CHEN T,PFEIFER J,et al.Aconstipation scoring system to simplify evaluation and management of constipated patients[J].Dis Colon Rectum,1996,39(6):681-685.
[7]白玉作.儿童功能性便秘的肠道管理[J].中华实用儿科临床杂志,2014,29(23):1774-1776.
[8]白铂亮,曲书强.儿童功能性便秘的研究现状[J].中华实用儿科临床杂志,2017,32(7):554-556.
[9]CLEMENTE J C,URSELL L K,PARFREY L W.The impact of the gut microbiota on human health:an integrative view[J].Cell,2012,148(6):1258-1270.
[10]CHOI C H,CHANG S K.Alteration of gut microbiota and efficacy of probiotics in functional constipation[J].J Neurogastroenterol Motil,2015,21(1):4-7.
[11]王中心,吕永庭.经腹腔镜和开腹结肠次全切除术治疗结肠慢传输性便秘的比较[J].武汉大学学报(医学版),2011,32(1):123-124,135.