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目的探讨恶性血液病患者化疗后肠道免疫功能及微生态改变状况。方法采用前瞻性队列研究。入选初发恶性血液病并需要化疗的患者,留取化疗前后粪便标本。根据患者化疗后是否出现发热,分为粒细胞减少伴发热组及粒细胞减少不伴发热组。采用光冈法对粪便需氧菌及厌氧菌进行定量培养,分析肠道菌群变化。同时检测患者化疗前后粪便IgA值变化。结果共纳入24例患者,化疗后出现粒细胞减少症伴发热的患者10例,占41.7%;未发热患者14例,占58.3%。24例患者化疗后粪便IgA水平及B/E值显著性下降,肠道微生态发生改变,具体表现为肠杆菌、假单胞菌及真菌显著增多。化疗后,粒细胞减少伴发热组与未发热组相比肠杆菌及真菌显著增多,两组患者粪便IgA水平、B/E值变化无明显差异。结论恶性血液病患者化疗后肠道免疫功能、微生物定植抗力下降,侵袭性细菌增多。化疗后粒细胞减少伴发热患者肠杆菌显著增多,可能成为粒细胞减少症伴发热患者的潜在致病菌。
Objective To investigate the changes of intestinal immune function and microecology after chemotherapy in patients with hematologic malignancies. Methods A prospective cohort study was conducted. Selected patients with initial hematologic malignancy who require chemotherapy, stool samples before and after chemotherapy. According to whether patients with fever after chemotherapy, divided into neutropenic fever group and neutropenia fever group. Quantitative culture of aerobic bacteria and anaerobic bacteria in feces was performed by Mitsunobu method, and the change of intestinal flora was analyzed. At the same time, the change of stool IgA before and after chemotherapy was detected. Results A total of 24 patients were enrolled. Ten patients (35.7%) with neutropenia and fever were found after chemotherapy, and 14 (58.3%) were non-febrile patients. After 24 weeks, the levels of IgA and B / E in the feces of the 24 patients decreased significantly, and the intestinal microecology changed. The specific manifestations of Enterobacteriaceae, Pseudomonas and fungi were significantly increased. Chemotherapy, granulocytopenia with fever group and non-fever group, enterobacteriaceae and fungi significantly increased, two groups of patients stool IgA levels, B / E values showed no significant difference. Conclusion The intestinal immune function, microbial colonization resistance and invasive bacteria increased after chemotherapy in patients with hematologic malignancies. After chemotherapy, patients with neutropenia fever significantly increased Enterobacteriaceae, may be a potential pathogenic bacteria in patients with neutropenia fever.