血清炎性指标与内毒素及sTREM-1在肺癌患者术后肺部感染中的临床意义  

Clinical significance of serum inflammatory indicators, endotoxin and sTREM-1 levels in postoperative pulmonary infection of lung cancer patients

作　　者：杨帆 冯亚民 齐良刚 YANG Fan;FENG Ya-min;QI Liang-gang(Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学公共卫生学院,山西太原030001 [2]临汾市第二人民医院普外科,山西临汾041000

出　　处：《中华医院感染学杂志》2019年第19期2916-2920,共5页Chinese Journal of Nosocomiology

基　　金：山西省卫生厅科研基金资助项目(20150382)

摘　　要：目的探讨血清降钙素原(PCT)和C-反应蛋白(CRP)与内毒素(ET)及可溶性人髓系细胞触发受体-1(Soluble triggering receptor 1 expressed on myeloid cells,sTREM-1)在肺癌患者术后肺部感染中的临床意义,并分析四个指标对肺癌患者术后并发肺部细菌感染的早期诊断价值。方法以2013年1月-2017年12月在临汾市第二人民医院行手术治疗的肺癌患者术后是否发生肺部感染为依据,将232例患者分为感染组40例和未感染组192例。分别检测两组患者术前、术后1 d、术后3 d的血清PCT、CRP、ET及sTREM-1水平,采用受试者工作曲线(ROC)分析血清PCT、CRP、ET及sTREM-1对肺癌患者术后肺部感染的早期诊断价值。结果感染患者共培养分离病原菌68株,其中革兰阴性菌46株占67.65%,以肺炎克雷伯菌为主;革兰阳性菌22株占32.35%,以肺炎链球菌为主。术后1 d、术后3 d感染组患者血清中PCT、CRP、ET及sTREM-1高于术前(P<0.05),术后3 d感染组患者血清中PCT水平低于术后1 d,血清中CRP水平高于术后1 d(P<0.05),术后1 d、术后3 d未感染组患者血清中PCT、CRP及sTREM-1水平高于术前(P<0.05),术后1 d感染组患者血清中PCT、CRP、ET及sTREM-1分别为(2.51±0.87)ng/ml、(58.36±12.35)mg/L、(0.53±0.21)EU/ml、(42.19±18.28)pg/ml,术后3 d感染组患者上述指标分别为(2.12±0.76)ng/ml、(63.54±9.48)mg/L、(0.45±0.18)EU/ml、(41.47±13.36)pg/ml均高于未感染组(P<0.001)。ROC曲线分析结果显示,ET、PCT、sTREM-1、CRP对肺癌患者术后并发肺部细菌感染的早期诊断价值依次降低,曲线下面积分别为0.892、0.861、0.794、0.743。结论肺癌术后并发肺部细菌感染患者血清PCT、CRP、ET及sTREM-1水平上升,四指标对肺部细菌感染均具有一定的诊断价值,ET和PCT的早期诊断价值更高。OBJECTIVE To investigate the clinical significance of the dynamic changes of serum procalcitonin(PCT),C-reactive protein(CRP),endotoxin(ET)and soluble human myeloid cell trigger receptor-1(sTREM-1)levels in postoperative pulmonary bacterial infection of lung cancer patients,and to analyze the early diagnostic value of these four indexes in postoperative pulmonary bacterial infection of lung cancer patients.METHODS Based on the occurrence of pulmonary infection after lung cancer surgery in Linfen Second People’s Hospital from Jan.2013 to Dec.2017,232 patients were divided into infected group(n=40)and uninfected group(n=192).The levels of serum PCT,CRP,ET and sTREM-1 were measured before,1 day after and 3 days after operation.The early diagnostic value of serum PCT,CRP,ET and sTREM-1 for postoperative pulmonary infection in patients with lung cancer was analyzed by receiver operating characteristic curve(ROC).RESULTS A total of 68 strains of pathogens were cultured,among which 46 strains of Gram-negative bacteria were detected,accounting for 67.65%,and there were 22 strains of Gram-positive bacteria,accounting for 32.35%,and Streptococcus pneumoniae was dominant.The levels of serum PCT,CRP,ET and sTREM-1 in the infected group at 1 d after operation and 3 d after operation were significantly higher than those before operation(P<0.05).The level of serum PCT in the infected group at 3 d after operation was significantly lower than that at 1 d after operation,and the level of serum CRP at 3 d after operation was significantly higher than that at 1 d after operation(P<0.05).The levels of serum PCT,CRP and sTREM-1 in the uninfected group at 1 d after operation and 3 d after operation were significantly higher than those before operation(P<0.05),the levels of serum PCT,CRP,ET and sTREM-1 in the infected group at 1 d after operation were(2.51±0.87)ng/ml,(58.36±12.35)mg/L,(0.53±0.21)EU/ml,(42.19±18.28)pg/ml respectively,and the above-mentioned indicators in the infected group at 3 d after operation were(2.12±0.76)ng/

关 键 词：肺癌 术后 肺部感染 降钙素原 C-反应蛋白 内毒素 可溶性人髓系细胞触发受体-1 

分 类 号：R563.1[医药卫生—呼吸系统]