食管癌患者胸腹腔镜术后呼吸道感染细胞因子变化  

Changes of cytokines in esophageal cancer patients with respiratory tract infection after thoracoscopic surgery

作　　者：卢万里[1] 朱正帅 裴书飞 金哲[1] 王铮[1] LU Wan-li;ZHU Zheng-shuai;PEI Shu-fei;JIN Zhe;WANG Zheng(Nanyang Central Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中心医院胸外科,河南南阳473000 [2]南阳市中心医院消化内科,河南南阳473000

出　　处：《中华医院感染学杂志》2020年第14期2169-2173,共5页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(编号:2016168)。

摘　　要：目的探究食管癌患者胸腹腔镜术后呼吸道感染细胞因子变化。方法选取2015年3月—2018年5月南阳市中心医院就诊的200例食管癌患者作为研究对象,所有入组患者均行胸腹腔镜手术,术后发生呼吸道感染患者24例为感染组,未发生感染患者176例为对照组;分析感染患者病原菌及病原菌的敏感率;检测外周血白细胞介素-2(IL-2)、IL-4、IL-10、IL-12、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)水平,采用受试者工作特征(ROC)曲线分析其诊断效能。结果 24例感染患者,共分离出89株病原菌,革兰阴性菌53株,革兰阳性菌35株,真菌1株;主要革兰阴性菌对头孢呋辛、头孢噻肟、亚胺培南敏感率较高,主要革兰阳性菌对万古霉素、替考拉宁、苯唑西林敏感率较高。与对照组比较,术后感染组细胞因子水平升高,差异有统计学意义(P<0.05)。ROC曲线分析显示,联合检测时诊断的灵敏度为95.85%、特异度为93.55%高于单一指标诊断。结论胸腹腔镜治疗食管癌术后呼吸道感染病原菌分布集中,检测IL-2、IL-4、IL-10、IL-12、TNF-α、IFN-γ变化,对早期诊断有一定的价值。OBJECTIVE To explore the changes of cytokines in the esophageal cancer patients with respiratory tract infection after thoracoscopic surgery.METHODS Totally 200 esophageal cancer patients who were treated in Nanyang Central Hospital from Mar 2015 to May 2018 were recruited as the study objects,all of the enrolled patients received thoracoscopic laparoscopic surgery,24 patients who had postoperative respiratory tract infection were assigned as the infection group,and 176 patients who did not have infection were assigned as the control group.The distribution and drug susceptibility rates of pathogens were observed,the levels of peripheral blood interleukin-2(IL-2),interleukin-4(IL-4),interleukin-10(IL-10),interleukin-12(IL-12),tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ)were detected,and the diagnostic efficiency was analyzed by using receiver operating characteristic(ROC)curve.RESULTS A total of 89 strains of pathogens were isolated from the 24 patients with infection,53 of which were gram-negative bacteria,35 were gram-positive bacteria,and 1 was fungus.The drug susceptibility rates of the main gram-negative bacteria to cefuroxime,cefotaxime and imipenem were high.The drug susceptibility rates of the main gram-positive bacteria to vancomycin,teicoplanin and oxacillin were high.The levels of cytokines of the infection group were significantly higher than those of the control group after the surgery,and there(P<0.05).ROC curve analysis sowed that the sensitivity and specificity of the joint detection of the indexes were respectively 95.85%and 93.55%,higher than those of the single index.CONCLUSION There is a concentrated distribution of pathogens isolated from the esophageal cancer patients with respiratory tract infection after thoracoscopic surgery.The detection of IL-2,IL-4,IL-10,IL-12,TNF-αand IFN-γhas certain value in early diagnosis.

关 键 词：食管癌 胸腹腔镜术 呼吸道感染 病原菌 细胞因子 临床意义 

分 类 号：R735.1[医药卫生—肿瘤]