| ObjectiveThe purpose of this study is to explore the clinical efficacy of thymectomy during radiotherapy in preventing acute radiation induced colitis in rectal cancer patients,as well as its impact on immune cell subpopulations,cytokines,and fecal microbiota.MethodA total of 80 postoperative rectal cancer patients who underwent pelvic radiotherapy at the Radiation Technology Center of Qingdao University Affiliated Hospital from October 2020 to September 2022 were included according to the inclusion and exclusion criteria.There were 39 cases in the experimental group and 41 cases in the control group.The experiment has been approved by the hospital ethics committee,and both groups of patients have agreed to be enrolled and signed an informed consent form.Patients in the control group were given adjuvant radiotherapy,and patients were instructed to take orally 825mg/m2 of capecitabine on the radiotherapy day,once in the morning and once in the evening,until the radiotherapy was completed.On the basis of the treatment in the control group,patients in the experimental group were given subcutaneous injection of thymosin 1.6mg twice a week,on Monday and Thursday,respectively,until one week after the end of radiotherapy.Observe the incidence and severity of radiation enteritis in two groups of patients from the beginning of radiotherapy to one week after the end of radiotherapy,as well as the first time and duration of radiation enteritis occurrence,and the KPS functional status score before and after treatment.Record the weekly blood routine results of two groups of patients and observe the incidence of acute bone marrow suppression in both groups;Collect peripheral blood and stool samples from two groups of patients one day before and one week after radiotherapy,observe CD4+T,CD8+T,CD4+/CD8+,NK cells,IL-1β、IL-6、IL-8、IL-10、TNF-αChanges in fecal microbiota.SPSS 25.0 software was used for statistical analysis,and t-test,X~2test,and rank sum test were used for inter group comparison based on data type.Result1.A total of 80 patients were enrolled in this study,including 39 in the experimental group and 41 in the control group,all of which completed this study.There is no significant difference(P>0.05)between the two groups in terms of gender,age,hypertension,diabetes,smoking history,KPS,tissue differentiation,postoperative pathological stage,nature of the incision margin,radiotherapy posture,and small intestine volume,which is comparable.2.From the beginning of radiotherapy to one week after the end of radiotherapy,a total of 34 cases(87.18%)in the experimental group developed acute radiation enteritis,while the control group all experienced varying degrees of acute radiation enteritis.The incidence rate of acute radiation enteritis in the experimental group was lower than that in the control group,with a statistically significant difference(X~2=8.216,P=0.042,P<0.05).3.The first appearance time of radiation induced enteritis in the experimental group was 16.23±3.47 days after radiotherapy;The first appearance time of radiation induced enteritis in the control group was 12.78±2.89 days after radiotherapy.The first occurrence time of the experimental group was later than that of the control group,and the difference was statistically significant(P<0.001).The duration of radiation induced enteritis in the experimental group was 16.30±7.35 days,while in the control group it was 18.66±5.95 days.4.There was no statistically significant difference between the two groups(P>0.05).After treatment,the KPS scores of both groups decreased compared to before treatment.After treatment,the KPS scores of the experimental group and the control group were81.02±5.980 and 78.29±5.432,respectively.The KPS scores of the experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).5.During the radiotherapy period,11(28.21%),7(17.95%),and 1(2.6%)cases of grade 1,2,and 3 acute bone marrow suppression occurred in the experimental group,while 12(29.27%),14(34.15%),and 4(9.8%)cases of grade 1,2,and 3 acute bone marrow suppression occurred in the control group;There was no statistically significant difference between the two groups(P>0.05).6.There was no statistically significant difference in CD4+T,CD8+T,CD4+/CD8+,and NK cells between the two groups before treatment(t=1.04,1.66,-0.92,1.64,P>0.05);After treatment,the levels of CD4+T,CD4+/CD8+,and NK cells in the experimental group increased compared to before treatment,while the levels of CD8+T decreased compared to before treatment(P<0.05);After treatment,the levels of CD4+T,CD4+/CD8+,and NK cells in the control group decreased compared to before treatment,while the levels of CD8+T increased compared to before treatment,with statistical significance(P<0.01);After treatment,the levels of CD4+T,CD4+T/CD8+T,and NK cells in the experimental group were higher than those in the control group,while the levels of CD8+T were lower than those in the control group,with a statistically significant difference(P<0.001).7.Two groups of IL-1β、IL-6、IL-8、IL-10、TNF-αThere was no statistically significant difference in horizontal comparison(t=0.47,1.36,-0.65,P>0.05).IL-1β、IL-6、IL-8、TNF-αThe levels were all higher than before treatment,and the difference was statistically significant(P<0.05).IL-6,IL-8,TNF-αThe level was lower than the control group,with a statistically significant difference(P<0.05),and the IL-10 level after treatment was higher than the control group(P<0.05).8.There was no statistically significant difference in the comparison of G-bacteria,G+cocci,and G+bacteria between the two groups before treatment(t=-1.97,0.52,1.74,P>0.05,respectively).After treatment,there were changes in the fecal microbiota in both the experimental group and the control group,mainly manifested as an increase in the proportion of G-bacteria and a decrease in the proportion of G+bacteria(P<0.001).However,there was no significant difference in the proportion of the three bacterial communities between the experimental group and the control group after treatment(P>0.05).ConclusionThe new application of thymic method in postoperative radiotherapy for rectal cancer can reduce the occurrence of radiation enteritis,delay the onset time,improve quality of life,and facilitate the smooth completion of treatment for patients.Its mechanism may be related to regulating the body’s immune function,reducing pro-inflammatory factors,and enhancing the release of anti-inflammatory factors. |
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