术前T淋巴细胞亚群减低对胸腔镜肺癌根治术后肺部感染发生的影响  

Effect of preoperative decrease of T lymphocyte subsets on pulmonary infection after thoracoscopic radical resection of lung cancer

作　　者：何锋[1] 王小英 刘宁[1] 陈新富[1] 陈树兴[1] HE Feng;WANG Xiao-ying;LIU Ning(Department of Thoracic Surgery,Fuzhou Pulmonary Hospital,Affiliated Teaching Hospital of Fujian Medical University,Fuzhou 350007,China)

机构地区：[1]福建医科大学附属教学医院福州肺科医院胸外科,福建福州350007

出　　处：《吉林医学》2022年第10期2626-2631,共6页Jilin Medical Journal

基　　金：福州市科技计划项目[项目编号:2020-WS-117];福州市2019年临床重点专科建设项目[项目编号:201912003]。

摘　　要：目的:探讨行胸腔镜肺癌根治术的非小细胞肺癌(NSCLC)患者术前T淋巴细胞亚群功能减低对发生术后肺部感染风险的影响。方法:采用流式细胞术检测法对行肺癌根治术的196例NSCLC患者于术前、术后第1天、术后第3天、术后第5天行外周血T淋巴细胞亚群检测,根据术前CD_(3)^(+)T淋巴细胞水平分为T淋巴细胞亚群功能减低组(23例)和T淋巴细胞亚群功能正常组(173例),比较两组患者术后肺部感染发生的差异。结果:NSCLC患者T淋巴细胞亚群减低组术后肺部感染发生率为26.1%(6/23);正常组术后肺部感染发生率为25.4%(44/173),两组间差异无统计学意义(P=0.946);采用二分类Logistic回归评估发现年龄、吸烟、淋巴结转移、手术时长、肺切除方式是术后肺部感染发生的独立危险因素,差异有统计学意义(P<0.05);CD_(3)^(+)、CD4^(+)、CD8^(+)T淋巴细胞比率减低不是术后肺部感染发生的独立危险因素,差异无统计学意义(P>0.05)。在血清炎性反应标志物比较中,两组间在细胞因子[白细胞介素(IL)-6、IL-8、IL-10]、血常规、C-反应蛋白(CRP)水平比较,差异无统计学意义(P>0.05),降钙素原(PCT)在术后第1天、第3天、第5天减低组较正常组低,差异有统计学意义(P<0.05)。两组患者术后T淋巴细胞亚群变化趋势大致相同,呈先降后升动态变化;术后第1天,正常组CD4^(+)T淋巴细胞比率下降较减低组显著,差异有统计学意义(P<0.05)。两组患者术后第5天CD_(3)^(+)、CD4^(+)T淋巴细胞比率高于术前,CD8^(+)T淋巴细胞比率低于术前水平。结论:NSCLC患者行胸腔镜肺癌根治术前T淋巴细胞亚群功能减低不增加术后肺部感染发生的风险。Objective To investigate the effect of preoperative T lymphocyte subsets dysfunction on the risk of postoperative pulmonary infection in patients with non-small cell lung cancer undergoing thoracoscopic radical resection.Method The peripheral blood T lymphocyte subsets of 196 NSCLC patients undergoing radical resection were detected by flow cytometry before operation, the first day after operation, the third day after operation and the fifth day after operation. According to the preoperative CD_(3)T lymphocyte level, they were divided into the T lymphocyte reduction group(23 cases) and the T lymphocyte normal group(173 cases). The differences in the occurrence of postoperative pulmonary infection between the two groups were compared.Results The incidence of postoperative pulmonary infection in the T lymphocyte reduction group of NSCLC patients was 26.1%(6/23);the incidence of postoperative pulmonary infection in the T lymphocyte normal group of NSCLC patients was 25.4%( 44/173), and there was no significant difference between the two groups(P=0.946). Logistic regression analysis showed that age, smoking, lymph node metastasis, operation time and lung resection were independent risk factors for pulmonary infection after radical resection(P<0.05). The decrease of CD_(3), CD4, CD8T lymphocyte ratio were not independent risk factors for postoperative pulmonary infection(P>0.05). In the comparison of perioperative serum inflammatory markers, there were no significant difference in cytokines(IL-6, IL-8, IL-10), blood routine and CRP levels between the two groups(P>0.05). The PCT level in the first day, the third day and the fifth day after operation was lower than that in the normal group(P<0.05).Two groups of patients with postoperative T lymphocyte subsets change trend was roughly the same, first decreased and then increased dynamic change;on the first day after operation, the percentage of CD4T lymphocytes in the normal group was significantly lower than that in the reduced group(P<0.05). The ratio of CD_(3)and CD4T

关 键 词：非小细胞肺癌 胸腔镜 肺癌根治术 T淋巴细胞亚群 免疫功能 肺部感染 

分 类 号：R734.2[医药卫生—肿瘤] R563.1[医药卫生—临床医学]