Effect of Probiotics on The Change of Intestinal Barrier Function and Inflammatory Response after Surgery of Colorectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIA Yang , QIN Huanlong

Department of General Surgery, The Affiliated Sixth People’s Hospital of Shanghai Jiaotong University, Shanghai 200233, China;

Corresponding author：

Keywords：

Probiotics; Intestinal permeability; Intestinal barrier function; Colorectal cancer

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Objective To study the effect of probiotics on the change of intestinal permeability and inflammatory reaction after surgery of colorectal cancer. Methods Sixty patients who underwent colonic surgery were randomly divided into two groups: probiotic group and control group, with 30 cases in each group. Each group received nutritional support of the same nitrogen and calorie from day 3 to day 7 after operation. The patients in probiotic group were orally administrated probiotic (2 g/d) from the first day after surgery for 7 days. Every patient’s body temperature and heart rate were observed after operation, and white blood cell counts were observed before operation and on day 1, 5, 8 after operation. The levels of microbial DNA in whole blood and plasma D-lactate, and urine lactulose/mannito (L/M) ratio were measured before operation and on day 1 and day 8 after operation, respectively. In addition, the occurrence of postoperative systemic inflammatory response syndrome (SIRS) and complications of inflammation were closely observed. Results The average heart rate in postoperative 5 days was significantly lower in probiotics group than that in control group (P＜0.01). The duration of fever and the recovery time for white blood cell counts decreasing to normal were significantly less in probiotics group than those in control group (P＜0.01) as well. There was no significant difference of positive rate of microbial DNA in peripheral blood on day 1 after operation between two groups. However, the number of patients that showed positive result of microbial DNA PCR test in probiotic group （1 case, 3.3%） was significantly less than that of control group (7 cases, 23.3%）on day 8 after operation (P＜0.05). The level of plasma D-lactate in probiotic group 〔decreasing from (6.90±1.41) ng/ml on day 1 to (0.56±0.18) ng/ml on day 8〕 was also significantly lower than that in control group 〔decreasing from (6.63±1.29) ng/ml on day 1 to (0.95±0.83) ng/ml on day 8〕 on day 8 after operation (P＜0.05). Urine L/M ratio increased from 0.053±0.019 on day 1 to 0.063±0.016 on day 8 after operation in control group; while in probiotic group, the ratio decreased from 0.047±0.012 on day 1 to 0.031±0.008 on day 8 after operation, and there was significantly statistical difference of the ratio between two groups on day 8 (P＜0.01). There was no significant difference of the occurrence rate of SIRS and complications of inflammation between two groups (P gt;0.05). Conclusion Probiotics can decrease intestinal permeability and maintain the intestinal barrier function after operation. It may be helpful for the recovery of patients with early inflammatory response after surgery of colorectal cancer.

Citation： XIA Yang,QIN Huanlong. Effect of Probiotics on The Change of Intestinal Barrier Function and Inflammatory Response after Surgery of Colorectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(11): 805-810. doi: Copy

1.
2.	吴承堂，黄祥成，杨希山, 等. 大肠癌术后肠屏障功能变化的临床研究 [Ｊ]. 中国普通外科杂志, 2003; 12（11）∶858.
3.	Klarin B, Johansson ML, Molin G, et al. Adhesion of the probiotic bacterium Lactobacillus plantarum 299v onto the gut mucosa in critically ill patients: a randomised open trial[Ｊ]. Crit Care, 2005; 9(3)∶R285.
4.	Kane TD, Alexander JW, Johannigman JA. The detection of microbial DNA in the blood: a sensitive method for diagnosing bacteremia and/or bacterial translocation in surgical patients[Ｊ]. Ann Surg, 1998; 227(1)∶1.
5.	于勇，盛志勇，柴家科，等. 烧伤患者血浆D-乳酸水平和肠道内IgA含量的变化 [Ｊ]. 创伤外科杂志, 2003; 5（2）∶122.
6.	Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[Ｊ]. Crit Care Med, 1992; 20(6)∶864.
7.	Madara JL. Maintenance of the macromolecular barrier at cell extrusion sites in intestinal epithelium: physiological rearrangement of tight junctions[Ｊ]. J Membr Biol, 1990; 116(2)∶177.
8.	Meddings JB, Swain MG. Environmental stress-induced gastrointestinal permeability is mediated by endogenous glucocorticoids in the rat[Ｊ]. Gastroenterology, 2000; 119(4)∶1019.
9.	Deitch EA. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure[Ｊ]. Arch Surg, 1990; 125(3)∶403.
10.	Sderholm JD, Perdue MH. Stress and gastrointestinal tract.Ⅱ. Stress and intestinal barrier function[Ｊ]. Am J Physiol Gastrointest Liver Physiol， 2001； 280(1)∶G7.
11.	张婧, 程中. 肠道微生态制剂及其临床应用和研究进展[Ｊ]. 中国普外基础与临床杂志, 2008; 15(6)∶463.
12.	Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition[Ｊ]. Am J Clin Nutr， 2001; 73(2 Suppl)∶361S.
13.	刘东红. 微生态制剂的进展与临床应用评价 [Ｊ]. 中国医院用药评价与分析, 2006; 6(3)∶139.
14.	范学工, 黄燕. 微生态制剂的临床应用 [Ｊ].中国实用内科杂志, 2002; 22(11)∶691.
15.	Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis[Ｊ].Med Sci Monit， 2004; 10(11)∶PI126.
16.	卜淑蕊，戴鹏，赵严，等. 益生菌对肝硬化血氨影响的实验及临床研究 [Ｊ]. 中国微生态学杂志, 2007； 19（1）∶25.
17.	Oláh A, Belágyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis[Ｊ]. Br J Surg， 2002; 89(9)∶1103.
18.	Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predict severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[Ｊ]. Lancet, 2008； 371(9613)∶651.
19.	Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy[Ｊ].Hepatogastroenterology， 2007; 54(75)∶661.
20.	Rayes N, Seehofer D, Müller AR, et al. Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery-results of a prospective trial[Ｊ]. Z Gastroenterol， 2002; 40(10)∶869.
21.	秦环龙，苏振东，范小兵，等. 益生菌对急性胰腺炎大鼠肠道微生态及紧密连接的影响 [Ｊ]. 中国临床营养杂志， 2006； 14（2）∶82.
22.	Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[Ｊ]. Gut， 2004; 53(2)∶241.

1.
2. 吴承堂，黄祥成，杨希山, 等. 大肠癌术后肠屏障功能变化的临床研究 [Ｊ]. 中国普通外科杂志, 2003; 12（11）∶858.
3. Klarin B, Johansson ML, Molin G, et al. Adhesion of the probiotic bacterium Lactobacillus plantarum 299v onto the gut mucosa in critically ill patients: a randomised open trial[Ｊ]. Crit Care, 2005; 9(3)∶R285.
4. Kane TD, Alexander JW, Johannigman JA. The detection of microbial DNA in the blood: a sensitive method for diagnosing bacteremia and/or bacterial translocation in surgical patients[Ｊ]. Ann Surg, 1998; 227(1)∶1.
5. 于勇，盛志勇，柴家科，等. 烧伤患者血浆D-乳酸水平和肠道内IgA含量的变化 [Ｊ]. 创伤外科杂志, 2003; 5（2）∶122.
6. Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[Ｊ]. Crit Care Med, 1992; 20(6)∶864.
7. Madara JL. Maintenance of the macromolecular barrier at cell extrusion sites in intestinal epithelium: physiological rearrangement of tight junctions[Ｊ]. J Membr Biol, 1990; 116(2)∶177.
8. Meddings JB, Swain MG. Environmental stress-induced gastrointestinal permeability is mediated by endogenous glucocorticoids in the rat[Ｊ]. Gastroenterology, 2000; 119(4)∶1019.
9. Deitch EA. The role of intestinal barrier failure and bacterial translocation in the development of systemic infection and multiple organ failure[Ｊ]. Arch Surg, 1990; 125(3)∶403.
10. Sderholm JD, Perdue MH. Stress and gastrointestinal tract.Ⅱ. Stress and intestinal barrier function[Ｊ]. Am J Physiol Gastrointest Liver Physiol， 2001； 280(1)∶G7.
11. 张婧, 程中. 肠道微生态制剂及其临床应用和研究进展[Ｊ]. 中国普外基础与临床杂志, 2008; 15(6)∶463.
12. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics-approaching a definition[Ｊ]. Am J Clin Nutr， 2001; 73(2 Suppl)∶361S.
13. 刘东红. 微生态制剂的进展与临床应用评价 [Ｊ]. 中国医院用药评价与分析, 2006; 6(3)∶139.
14. 范学工, 黄燕. 微生态制剂的临床应用 [Ｊ].中国实用内科杂志, 2002; 22(11)∶691.
15. Tursi A, Brandimarte G, Giorgetti GM, et al. Low-dose balsalazide plus a high-potency probiotic preparation is more effective than balsalazide alone or mesalazine in the treatment of acute mild-to-moderate ulcerative colitis[Ｊ].Med Sci Monit， 2004; 10(11)∶PI126.
16. 卜淑蕊，戴鹏，赵严，等. 益生菌对肝硬化血氨影响的实验及临床研究 [Ｊ]. 中国微生态学杂志, 2007； 19（1）∶25.
17. Oláh A, Belágyi T, Issekutz A, et al. Randomized clinical trial of specific lactobacillus and fibre supplement to early enteral nutrition in patients with acute pancreatitis[Ｊ]. Br J Surg， 2002; 89(9)∶1103.
18. Besselink MG, van Santvoort HC, Buskens E, et al. Probiotic prophylaxis in predict severe acute pancreatitis: a randomized, double-blind, placebo-controlled trial[Ｊ]. Lancet, 2008； 371(9613)∶651.
19. Nomura T, Tsuchiya Y, Nashimoto A, et al. Probiotics reduce infectious complications after pancreaticoduodenectomy[Ｊ].Hepatogastroenterology， 2007; 54(75)∶661.
20. Rayes N, Seehofer D, Müller AR, et al. Influence of probiotics and fibre on the incidence of bacterial infections following major abdominal surgery-results of a prospective trial[Ｊ]. Z Gastroenterol， 2002; 40(10)∶869.
21. 秦环龙，苏振东，范小兵，等. 益生菌对急性胰腺炎大鼠肠道微生态及紧密连接的影响 [Ｊ]. 中国临床营养杂志， 2006； 14（2）∶82.
22. Anderson AD, McNaught CE, Jain PK, et al. Randomised clinical trial of synbiotic therapy in elective surgical patients[Ｊ]. Gut， 2004; 53(2)∶241.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of Probiotics on The Change of Intestinal Barrier Function and Inflammatory Response after Surgery of Colorectal Cancer

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