Pancreatic exocrine insufficiency (PEI) is common amongst pancreatic cancer patients and is associated with poorer treatment outcomes. Pancreatic enzyme replacement therapy (PERT) is known to improve outcomes in pancreatic cancer, but the mechanisms are not fully understood. The aim of this narrative literature review is to summarise the current evidence linking PEI with microbiome dysbiosis, assess how microbiome composition may be impacted by PERT treatment, and look towards possible future diagnostic and therapeutic targets in this area. Early evidence in the literature reveals that there are complex mechanisms by which pancreatic secretions modulate the gut microbiome, so when these are disturbed, as in PEI, gut microbiome dysbiosis occurs. PERT has been shown to return the gut microbiome towards normal, so called rebiosis, in animal studies. Gut microbiome dysbiosis has multiple downstream effects in pancreatic cancer such as modulation of the immune response and the response to chemotherapeutic agents. It therefore represents a possible future target for future therapies. In conclusion, it is likely that the gut microbiome of pancreatic cancer patients with PEI exhibits dysbiosis and that this may potentially be reversible with PERT. However, further human studies are required to determine if this is indeed the case.
胰腺外分泌功能不全（PEI）在胰腺癌患者中较为常见，且与较差的治疗结局相关。已知胰酶替代疗法（PERT）可改善胰腺癌患者的预后，但其作用机制尚未完全阐明。本文旨在通过叙述性文献综述，总结当前关于PEI与肠道菌群失调关联的证据，评估PERT治疗对肠道菌群组成的影响，并探讨该领域未来可能的诊断与治疗靶点。现有早期证据表明，胰腺分泌物通过复杂机制调节肠道菌群，当这种调节机制被破坏（如发生PEI时），就会导致肠道菌群失调。动物研究显示，PERT能使肠道菌群恢复正常状态，即实现所谓的"菌群重建"。肠道菌群失调在胰腺癌中会产生多重下游效应，包括调节免疫应答及影响化疗药物反应，因此可能成为未来治疗的潜在靶点。综上所述，伴有PEI的胰腺癌患者很可能存在肠道菌群失调，且PERT可能逆转这种失调状态，但尚需进一步的人体研究加以验证。
肿瘤(癌症)患者之家