Department of General Surgery, Infanta Elena University Clinical Hospital, 21080 Huelva, Spain.
Department of General Surgery, Juan Ramón Jiménez University Clinical Hospital, 21005 Huelva, Spain.
Biomolecules. 2021 May 2;11(5):684. doi: 10.3390/biom11050684.
Diversion colitis is a non-specific inflammation of a defunctionalised segment of the colon after a temporary stoma has been performed. This inflammation is associated with an alteration of certain inflammatory serum markers. The aims of this study were, firstly, to evaluate the modification of inflammatory biomarkers after stimulation with probiotics prior to closure of the protective ileostomy. Secondly, to identify if a relationship could be established between the severity of diversion colitis and the alteration of inflammatory biomarkers in the blood. A prospective, randomized, double-blind, controlled study was conducted. Patients who underwent surgery for colorectal carcinoma with protective ileostomy between January 2017 and December 2018 were included, pending reconstructive surgery and with diversion colitis as diagnosis. The sample was randomly divided into a group stimulated with probiotics (SG) ( = 34) and a control group (CG) ( = 35). Histological and endoscopic changes were evaluated after stimulation, after restorative surgery and during the short-term follow-up after surgery, including the correlation with pro-inflammatory biomarkers in blood. As main findings, a significant decrease in C-reactive protein (CRP), Neutrophil/lymphocyte ratio (NLR ratio), and monocyte/lymphocyte ratio (LMR ratio) was observed in the SG versus the CG with a < 0.001. A significant increase in transferrin values and in the platelet/lymphocyte ratio (PLR) was observed in the SG versus CG after stimulation with probiotics with a < 0.001. A normalisation of CRP and transferrin levels was observed in the third month of follow-up after closure ileostomy, and NLR, LMR and PLR ratios were equal in both groups. Decreased modified Glasgow prognostic score was found in SG compared to CG after probiotic stimulation ( < 0.001). The endoscopic and histological severity of diversion colitis is associated with a greater alteration of blood inflammatory biomarkers. The stimulation with probiotics prior to reconstructive surgery promotes an early normalization of these parameters.
转移结肠炎是一种在临时性造口术后，功能失调的结肠段发生的非特异性炎症。这种炎症与某些炎症性血清标志物的改变有关。本研究的目的首先是评估在保护性回肠造口关闭前，用益生菌刺激后，炎症生物标志物的变化。其次，确定炎症生物标志物在血液中的改变与转移结肠炎的严重程度之间是否存在关系。本研究为前瞻性、随机、双盲、对照研究。纳入了 2017 年 1 月至 2018 年 12 月期间因结直肠癌而行保护性回肠造口术的患者，等待重建手术，并诊断为转移结肠炎。将样本随机分为益生菌刺激组（SG）（n = 34）和对照组（CG）（n = 35）。在刺激后、重建手术后和手术后短期随访期间评估组织学和内镜变化，并与血液中的促炎生物标志物相关联。主要发现是，SG 组与 CG 组相比，C 反应蛋白（CRP）、中性粒细胞/淋巴细胞比值（NLR 比值）和单核细胞/淋巴细胞比值（LMR 比值）显著降低，差异有统计学意义（p < 0.001）。SG 组在接受益生菌刺激后，转铁蛋白值和血小板/淋巴细胞比值（PLR）显著升高，与 CG 组相比差异有统计学意义（p < 0.001）。在关闭回肠造口术后第三个月的随访中，CRP 和转铁蛋白水平恢复正常，两组 NLR、LMR 和 PLR 比值相等。与 CG 组相比，SG 组在益生菌刺激后的改良格拉斯哥预后评分（mGPS）降低（p < 0.001）。转移结肠炎的内镜和组织学严重程度与血液炎症生物标志物的改变更相关。重建手术前用益生菌刺激可促进这些参数的早期正常化。
