目的 探讨胃癌患者化疗期间肠道菌群特征与腹泻发生风险的相关性。 方法 选取 2018 年 8 月至 2022 年 2 月淮安 市第一人民医院肿瘤内科收治的 120 例接受胃癌根治术的患者为研究对象,术后所有患者均接受化疗,以化疗期间是否发生 腹泻分为发生组和未发生组。 采集所有患者新鲜成形粪便通过 16S rDNA 基因测序测定肠道菌群,对比两组肠道菌群特征以 及肠道菌群组成及差异,采用多因素 Logistic 回归分析影响腹泻发生的相关因素;绘制受试者操作特征(ROC)曲线,通过曲线 下面积(AUC)分析肠道菌群特征对化疗腹泻的指导价值。 结果 采用 16S rDNA 基因测序对 120 例粪便菌群样本分析,发生组 Shannon 指数(2. 92±0. 43)、Simpson 指数(1. 71±0. 63)、Chao1 指数(781. 26±124. 26)以及 Ace 指数(7635. 26±225. 74)和未发 生组(2. 38±0. 61)、(1. 95±0. 72)、(715. 26±147. 25)、(7706. 68±2534. 68)对比差异无统计学意义(P>0. 05),发生组 Beta 多样 性(0. 31±0. 10)低于未发生组(0. 46±0. 13),(P<0. 05)。 患者粪便菌群序列主要分属于 4 个菌门,包括放线菌门(Proteobacteria)、厚壁菌门(Firmicutes)、拟杆菌门(Bacteroidetes)、变形菌门(Proteobacteria)。 发生组放线菌门(5. 56± 1. 05)、厚壁菌门 (69. 64±2. 06)、拟杆菌门( 16. 75± 2. 19) 以及变形菌门( 18. 26± 2. 74) 和未发生组( 4. 42 ± 0. 74)、( 72. 65 ± 1. 54)、( 12. 17 ± 1. 15)、(7. 68±1. 36) 组成差异组间对比具有统计学意义( P < 0. 05)。 多因素 Logistic 回归结果显示 Beta 多样性( OR = 1. 320, 95%CI = 1. 110~ 1. 570)是腹泻发生的危险因素,拟杆菌门(OR = 0. 761,95%CI = 0. 629 ~ 0. 921)以及放线菌门(OR = 0. 255,95%CI = 0. 120~ 0. 542)是腹泻发生的保护因素(P<0. 05)。 结论 对于接受化疗的胃癌患者而言,肠道菌群多样性的改 变以及组成是化疗期间腹泻发生的相关因素,因此可通过肠道菌群的改变有针对性地予以用药指导。

Objective To explore the correlation between intestinal flora characteristics and diarrhea risk in patients with gastric cancer during chemotherapy. Method 120 patients with gastric cancer who underwent radical gastrectomy from August 2018 to February 2022 in the Department of Oncology of the First People's Hospital of Huai'an were selected as the research object. All patients received chemotherapy after operation and were divided into two groups according to whether diarrhea occurred during chemotherapy or not. The intestinal flora was determined by 16S rDNA gene sequencing and the characteristics composition and differences of intestinal flora were compared between the two groups. The related factors affecting diarrhea were analyzed by multivariate Logistic regression. Draw receiver operating characteristic curve ROC and analyze the characteristics of intestinal flora through the area under the curve AUC to guide the chemotherapy diarrhea. Result 16S rDNA gene sequencing was used to analyze 120 fecal flora samples Shannon's index 2. 92 ± 0. 43 Simpson 's index 1. 71 ± 0. 63 Chao1 's index 781. 26 ± 124. 26 and Ace index 7635. 26±225. 74 in the occurrence group and those in the non-occurrence group 2. 38±0. 61 、 1. 95±0. 72 、 715. 26±147. 25 、 7706. 68±2534. 68 . There was no significant difference P>0. 05 . The Beta diversity in the occurrence group 0. 31±0. 10 was lower than that in the non-occurrence group 0. 46±0. 13 P < 0. 05 . The sequence of patients' fecal flora mainly belongs to four phyla including Proteobacteria Firmicutes Bacteroidetes and Proteobacteria. In the occurrence group Actinomycetes 5. 56±1. 05 Firmicutes 69. 64±2. 06 Bacteroides 16. 75±2. 19 Proteobacteria 18. 26±2. 74 and non-occurrence groups 4. 42±0. 74 72. 65±1. 55 . Multivariate Logistic regression results showed that Beta diversity OR= 1. 320 95%CI = 1. 110-1. 570 was the risk factors for diarrhea Bacteroides OR = 0. 761 95%CI = 0. 629-0. 921 and Actinomycetes OR= 0. 255 95%CI = 0. 120-0. 521 were a protective factor in the occurrence of diarrhea. Conclusion For patients with gastric cancer receiving chemotherapy the change and composition of intestinal flora are the related factors of diarrhea during chemotherapy so we can give targeted medication guidance through the change of intestinal flora.