胃癌放疗期间医院感染影响因素及NEUT、sTNF-R1水平变化  

Influencing factors for nosocomial infection in gastric cancer patients during radiotherapy and levels of NEUT and sTNF-R1

作　　者：郭泽霞 符岸秋 卓恩挺 吴开李 叶学嫦 GUO Ze-xia;FU An-qiu;ZHUO En-ting;WU Kai-li;YE Xue-chang(Sanya Central Hospital,Sanya,Hainan 572000,China)

机构地区：[1]三亚中心医院普通外科,海南三亚572000 [2]三亚中心医院护理部,海南三亚572000 [3]三亚中心医院ICU,海南三亚572000

出　　处：《中华医院感染学杂志》2021年第9期1387-1390,共4页Chinese Journal of Nosocomiology

基　　金：海南省卫生计生行业科研基金资助项目(19A200188)。

摘　　要：目的探究胃癌患者放疗期间并发医院感染病原菌分布及影响因素,观察感染后血清炎症指标水平变化。方法选取2018年1月-2020年1月三亚中心医院收治的199例胃癌患者作为研究对象,均采取3周调强放疗(IMRT),分析放疗期间医院感染发生率及感染病原菌分布,单因素及多因素Logistic回归分析胃癌放疗期间医院感染的影响因素,比较感染患者与未感染患者可溶性肿瘤坏死因子受体1(sTNF-R1)、中性粒细胞(NEUT)、降钙素原(PCT)及C-反应蛋白(CRP)水平变化。结果199例胃癌患者中21例在放疗期间出现了医院感染,感染率为10.55%(21/199),共检出38株病原菌;单因素及多因素Logistic回归分析结果,患者年龄≥55岁、住院时间≥2周、临床分期Ⅳ期、接受化疗、使用抗菌药物、侵入性操作以及合并其他疾病是胃癌放疗期间发生医院感染的影响因素(P<0.05);感染患者血清PCT、CRP、sTNF-R1、NEUT水平高于未感染患者(P<0.05)。结论胃癌放疗期间发生医院感染以革兰阴性菌为主,临床要警惕具有以下情况的患者,例如年龄≥55岁、住院时间≥2周、临床分期Ⅳ期、接受化疗、使用抗菌药物、侵入性操作以及合并其他疾病,可根据实际情况检测血清PCT、CRP、sTNF-R1、NEUT指标来初步诊断感染的发生。OBJECTIVE To explore the distribution of pathogens and influencing factors for concurrent nosocomial infection in gastric cancer patients during radiotherapy and observe the changes of serum inflammatory factors.METHODS Totally 199 gastrin cancer patients who were treated in Sanya Central Hospital from Jan.2018 to Jan.2020 were recruited as the study subjects,all the patients were treated with intensity modulated radiation therapy(IMRT).The incidence of nosocomial infection and distribution of pathogens were investigated,univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection,and the levels of soluble tumor necrosis factor receptor I(sTNF-R1),neutrophils(NEUT),procalcitonin(PCT)and C-reactive protein(CRP)were observed and compared between the patients with infection and the patients without infection.RESULTS Of the 199 gastric cancer patients,21 had nosocomial infection during the radiotherapy,with the infection rate 10.55%(21/199).A total of 38 strains of pathogens were isolated.The results of univariate analysis and multivariate logistic regression analysis showed that the no less than 55 years of age,length of hospital stay no less than 2 weeks,clinical stageⅣ,chemotherapy,use of antibiotics,invasive procedures and complication with other diseases were the influencing factors for the nosocomial infection during the radiotherapy(P<0.05).The levels of serum PCT,CRP,sTNF-R1 and NEUT of the patients with infection were significantly higher than those of the patients without infection(P<0.05).CONCLUSION Gram-negative bacteria are dominant among the pathogens isolated from the gastric cancer patients with nosocomial infection during the radiotherapy.It is necessary for the clinicians to focus on the patients with no less than 55 years of age,length of hospital stay no less than 2 weeks,clinical stageⅣ,chemotherapy,use of antibiotics,invasive procedures and complication with other diseases and make a primary diagnosis of infection b

关 键 词：胃癌 医院感染 病原菌种类 危险因素 血清指标 

分 类 号：R735.2[医药卫生—肿瘤]