肠道菌群调控对结直肠癌奥沙利铂化疗的毒性改善作用的Meta分析

Meta-Analysis of the Effect of Intestinal Microbiota Regulation on the Improvement of Chemotherapy Toxicity with Oxaliplatin in Colorectal Cancer

摘要: 目的：通过系统评价分析肠道菌群的调节对人结直肠癌(CRC)奥沙利铂化疗的毒性改善作用。为奥沙利铂在临床应用提供循证证据。方法：系统检索中英文数据库(CNKI、Wanfang、PubMed、维普、Cochrane Library、Web of Science和Embase等)，筛选评估肠道菌群干预对奥沙利铂毒性作用的随机对照试验(RCT)，文献检索自建库终止于2025-03-01。本文利用Stata/MP 16.0软件进行Meta分析。结果：纳入10篇国内RCT，共计844名患者，实验组421例，对照组423例。Meta分析显示：腹泻、腹部膨胀、恶心呕吐、临床疗效、神经毒素的指标分别为[RR = 0.332, (95% CI: 0.214~0.517), Z = −4.895, P = 0.000]、[RR = 0.429, (95% CI: 0.255~0.720), Z = −3.205, P = 0.001]、[RR = 0.638, (95% CI: 0.504~0.808), Z = −3.737, P = 0.000]、[RR = 1.476, (95% CI: 1.161~1.875), Z = 3.184, P = 0.001]、[RR = 0.419, (95% CI: 0.233~0.754), Z = −2.902, P = 0.004]；微生态制剂可以降低CA199数量(WMD: −6.961, P = 0.021)、D-乳酸含量(WMD: −3.88, P < 0.05)，升高CRC化疗患者的乳酸杆菌水平(WMD: 0.993, P = 0.005)、降低大肠杆菌水平(WMD: −0.840, P = 0.003)。结论：我国结直肠癌奥沙利铂化疗患者，化疗期间使用肠道菌群调控可以减少患者化疗药物所致的部分不良反应，预防肠道微生态系统失衡，增强患者的免疫力，改善患者化疗期间的生活质量。

Abstract: Objective: To conduct a systematic review and analysis to evaluate the effect of intestinal microbiota regulation on the improvement of the toxicity of oxaliplatin chemotherapy in patients with colorectal cancer (CRC). To provide evidence-based evidence for the clinical application of oxaliplatin. Methods: Systematic searches were conducted in Chinese and English databases (CNKI, Wanfang, PubMed, VIP, Cochrane Library, Web of Science, and Embase, etc.). Randomized controlled trials (RCTs) evaluating the effect of intestinal microbiota intervention on the toxicity of oxaliplatin were screened. The literature search was terminated on March 1, 2025. This study used Stata/MP 16.0 software for Meta-analysis. Results: Ten domestic RCTs were included, involving a total of 844 patients. There were 421 cases in the experimental group and 423 cases in the control group. The Meta-analysis showed: the indicators of diarrhea, abdominal distension, nausea and vomiting, clinical efficacy, and neurotoxin were [RR = 0.332, (95% CI: 0.214~0.517), Z = −4.895, P = 0.000], [RR = 0.429, (95% CI: 0.255~0.720), Z = −3.205, P = 0.001], [RR = 0.638, (95% CI: 0.504~0.808), Z = −3.737, P = 0.000], [RR = 1.476, (95% CI: 1.161~1.875), Z = 3.184, P = 0.001], [RR = 0.419, (95% CI: 0.233~0.754), Z = −2.902, P = 0.004]; Microbial preparations can reduce the number of CA199 (WMD: −6.961, P = 0.021), D-lactic acid content (WMD: −3.88, P < 0.05), increase the level of Lactobacillus in CRC chemotherapy patients (WMD: 0.993, P = 0.005), and reduce the level of Escherichia coli (WMD: −0.840, P = 0.003). Conclusion: For patients with colorectal cancer undergoing oxaliplatin chemotherapy in China, using intestinal microbiota regulation during chemotherapy can reduce some adverse reactions caused by chemotherapy drugs, prevent imbalance of intestinal microecosystem, enhance the immunity of patients, and improve the quality of life of patients during chemotherapy.