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中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2016, Vol. 09 ›› Issue (04) : 217 -221. doi: 10.3877/cma.j.issn.1674-6880.2016.04.001

所属专题： 文献；

营养与代谢

艰难梭菌感染对结直肠癌患者营养及代谢的影响
童舟1, 罗芸2, 刘璐璐1, 郑怡1, 蒋微琴1, 陈晓刚3, 赵鹏1, 金大智2, 方维佳1,†()   
  1. 1. 310003　杭州，浙江大学医学院附属第一医院肿瘤细胞生物治疗中心
    2. 310051　杭州，浙江省疾病预防控制中心细菌检验科
    3. 310003　杭州，浙江大学医学院附属第一医院检验科
  • 收稿日期:2016-06-24 出版日期:2016-08-01
  • 通信作者: 方维佳
  • 基金资助:
    教育厅课题资助(Y201430628); 国家自然科学基金(81472210、81471998、81472346); 浙江省自然科学基金(LY15H160013、LQ14H160009); 2015-2016年浙江省重点研发计划(2015C03048); 浙江省医药卫生重大科技计划(WKJ-ZJ-1507)

Effect of Clostridium difficile infection on nutrition and metabolism of patients with colorectal cancer

Zhou Tong1, Yun Luo2, Lulu Liu1, Yi Zheng1, Weiqin Jiang1, Xiaogang Chen3, Peng Zhao1, Dazhi Jin2, Weijia Fang1,†()   

  1. 1. Cancer Biotherapy Centre, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
    2. Deparment of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
    3. Department of Clinical Laboratory, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
  • Received:2016-06-24 Published:2016-08-01
  • Corresponding author: Weijia Fang
  • About author:
    Corresponding author: Fang Weijia, Email:
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童舟, 罗芸, 刘璐璐, 郑怡, 蒋微琴, 陈晓刚, 赵鹏, 金大智, 方维佳. 艰难梭菌感染对结直肠癌患者营养及代谢的影响[J]. 中华危重症医学杂志(电子版), 2016, 09(04): 217-221.

Zhou Tong, Yun Luo, Lulu Liu, Yi Zheng, Weiqin Jiang, Xiaogang Chen, Peng Zhao, Dazhi Jin, Weijia Fang. Effect of Clostridium difficile infection on nutrition and metabolism of patients with colorectal cancer[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2016, 09(04): 217-221.

目的

探究艰难梭菌感染对结直肠癌患者营养及代谢的影响。

方法

留取205例肠癌患者术前粪便样本，根据有无艰难梭菌感染分成感染组（33例）及未感染组（172例），并在肿瘤浸润深度（T1、T2、T3、T4）、淋巴转移个数（N0、N1、N2）、隐血试验等因素下，检测两组患者的白蛋白、总蛋白水平。同时，比较两组患者在是否超重（体质量指数≥ 24）及不同性别下的游离脂肪酸水平，并根据患者年龄是否≥ 60岁进一步分组比较游离脂肪酸水平。

结果

感染组T4患者的白蛋白[（38 ± 3）g/L vs.（41 ± 5）g/L，t=2.211，P<0.05]和总蛋白[（63 ± 7）g/L vs.（68 ± 6）g/L，t=2.424，P<0.05]均较未感染组显著降低。且感染组隐血试验阳性患者的白蛋白[（38 ± 5）g/L vs.（42 ± 4）g/L，t=2.904，P<0.05]和总蛋白[（64 ± 8）g/L vs.（68 ± 6）g/L，t=2.537，P<0.05]水平较未感染组亦显著降低。而感染组N2患者中仅总蛋白较未感染组显著降低[（64 ± 5）g/L vs.（69 ± 6）g/L，t=2.085，P<0.05]。感染组超重[（0.25 ± 0.12）mmol/L vs.（0.38 ± 0.21）mmol/L，t=3.191，P<0.05]及男性患者[（0.26 ± 0.12）mmol/L vs.（0.37 ± 0.20）mmol/L，t=3.239，P<0.05]的游离脂肪酸水平较未感染组显著下降，且年龄≥ 60岁的超重[（0.24 ± 0.13）mmol/L vs.（0.38 ± 0.22）mmol/L，t=2.143，P<0.05]及男性[（0.23 ± 0.12）mmol/L vs.（0.37 ± 0.21）mmol/L，t=3.392，P<0.05]感染者较未感染者的游离脂肪酸水平更低。

结论

艰难梭菌感染的T4及隐血试验阳性的结直肠癌患者易引起白蛋白、总蛋白下降；超重、男性的老年感染患者更易出现脂肪代谢紊乱。

关键词: 艰难梭菌, 结直肠癌, 感染, 代谢
Objective

To evaluate the effect of Clostridium difficile infection (CDI) on nutrition and metabolism of patients with colorectal cancer (CRC).

Methods

Stool samples were collected from 205 preoperative CRC patients who were scheduled to have radical cancer resection. The samples were divided into the CDI group (33 cases) and non-CDI group (172 cases). The levels of albumin and total protein at different T stage, N stage, occult blood (OB) test were detected, and the levels of free fatty acid in whether being overweighted [body mass index (BMI) ≥ 24] and gender were measured. Meanwhile, the samples in BMI ≥ 24 and male were further divided into two subgroups according to the age whether ≥ 60 years old, and the levels of free fatty acid were compared.

Results

The levels of albumin [(38 ± 3)g/L vs. (41 ± 5) g/L, t=2.211, P<0.05], total protein [(63 ± 7) g/L vs. (68 ± 6) g/L, t=2.424, P<0.05] at T4 (tumour penetrates the serosa) in the CDI group were much lower than those in the non-CDI group. The levels of albumin [(38 ± 5)g/L vs. (42 ± 4) g/L, t=2.904, P<0.05], total protein [(64 ± 8) g/L vs. (68 ± 6) g/L, t=2.537, P<0.05] at OB positive in the CDI group also decreased markedly as compared with the non-CDI group. However, the total protein levels only at N2 (lymph nodes metastasis more than 3) in the CDI group was much lower than those in the non-CDI group [(64 ± 5) g/L vs. (69 ± 6) g/L, t=2.085, P<0.05]. Meanwhile, the levels of free fatty acid at BMI ≥ 24 [(0.25 ± 0.12) mmol/L vs. (0.38 ± 0.21) mmol/L, t=3.191, P<0.05] and male [(0.26 ± 0.12) mmol/L vs. (0.37 ± 0.20) mmol/L, t=3.239, P<0.05] decreased markedly in the CDI group as compared with the non-CDI group. After further subgrouping, the levels of free fatty acid with age ≥ 60 years old at BMI ≥ 24 [(0.24 ± 0.13) mmol/L vs. (0.38 ± 0.22) mmol/L, t=2.143, P<0.05] and male [(0.23 ± 0.12) mmol/L vs. (0.37 ± 0.21) mmol/L, t=3.392, P<0.05] in the CDI group were much lower than those in the non-CDI group.

Conclusions

CDI can reduce the serum levels of albumin, total protein and free fatty acid of T4 and OB positive CRC patients. Dyslipidiaemia can occur in CRC patients with CDI who were over 60 years old in BMI ≥ 24 and male population.

Key words: Clostridium difficile, Colorectal neoplasms, Infection, Metabolism
表1 两组结直肠癌患者在不同肿瘤浸润深度、淋巴结转移及粪便隐血试验白蛋白水平的比较（g/L，±s）
组别 例数 肿瘤浸润深度
T1 T2 T3 T4
感染组 33 42 ± 4 45 ± 5 43 ± 5 38 ± 3
未感染组 172 45 ± 5 44 ± 3 41 ± 5 41 ± 5
t值 ? 1.784 0.867 1.037 2.211
P值 ? 0.135 0.390 0.303 0.031
组别 例数 肿瘤淋巴结转移个数 粪便隐血试验
N0 N1 N2 阳性 阴性
感染组 33 43 ± 5 41 ± 6 39 ± 5 38 ± 5 44 ± 4
未感染组 172 42 ± 5 41 ± 5 42 ± 4 42 ± 4 43 ± 5
t值 ? 0.147 0.017 1.760 2.904 0.757
P值 ? 0.883 0.987 0.087 0.004 0.451
表2 两组结直肠癌患者在不同肿瘤浸润深度、淋巴结转移及粪便隐血试验总蛋白水平的比较（g/L，±s）
组别 例数 肿瘤浸润深度
T1 T2 T3 T4
感染组 33 64 ± 5 71 ± 6 68 ± 5 63 ± 7
未感染组 172 65 ± 8 70 ± 5 68 ± 6 68 ± 6
t值 ? 1.131 0.808 0.185 2.424
P值 ? 0.390 0.423 0.854 0.019
组别 例数 肿瘤淋巴结转移个数 粪便隐血试验
N0 N1 N2 阳性 阴性
感染组 33 68 ± 7 68 ± 8 64 ± 5 64 ± 8 69 ± 6
未感染组 172 68 ± 6 69 ± 6 69 ± 6 68 ± 6 69 ± 7
t值 ? 0.137 0.586 2.085 2.537 0.054
P值 ? 0.892 0.560 0.045 0.012 0.957
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