食管癌患者外周血CD_(14)^(+)单核细胞TLR4变化与肺部感染的关系  

Relationship between change of TLR4 in peripheral blood CD_(14)^(+)mononuclear cells and pulmonary infection in esophageal cancer patients

作　　者：陈栋 王培[1] 马红兵[1] 李勇[1] 施巩宁[1] CHEN Dong;WANG Pei;MA Hong-bing;LI Yong;SHI Gong-ning(Huaihe Hospital of Henan University,Kaifeng,Henan 475000,China)

机构地区：[1]河南大学淮河医院胸心血管外科,河南开封475000

出　　处：《中华医院感染学杂志》2022年第21期3287-3291,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建基金资助项目(LHGJ20210575)。

摘　　要：目的探究食管癌患者外周血CD_(14)^(+)单核细胞Toll样受体4(TLR4)变化与肺部感染的关系。方法选择2017年1月-2021年1月河南大学淮河医院行食管癌手术患者262例为研究对象,分为术后肺部感染组49例,未感染组213例。对口咽部菌群进行鉴定及药敏试验,比较两组患者外周血CD_(14)^(+)单核细胞TLR4表达,分析食管癌患者术后肺部感染的影响因素。结果感染组细菌阳性培养结果高于未感染组;所有革兰阴性菌均对氨苄西林、哌拉西林有较高耐药性,对亚胺培南耐药性均较低;金黄色葡萄球菌、溶血葡萄球菌均对青霉素、阿莫西林表现出较高耐药性,普遍对利福平、万古霉素的耐药性较低;感染组外周血CD_(14)^(+)单核细胞TLR4阳性细胞百分率及MFI均高于未感染组(P<0.05);多因素分析显示,年龄≥60岁、合并糖尿病、合并慢性阻塞性肺疾病(COPD)、存在吸烟史是食管癌患者术后肺部感染的危险因素。结论食管癌术后肺部感染患者存在口咽部菌群失调情况,且外周血CD_(14)^(+)单核细胞TLR4表达低于未感染患者,因此临床要注意加强患者术后口腔卫生,并注重外周血CD_(14)^(+)单核细胞TLR4的观测,同时对于年龄较大、存在糖尿病、COPD、吸烟史患者术后应加强呼吸道引流及抗感染的治疗。OBJECTIVE To explore the relationship between the change of Toll-like receptor 4(TLR4)in peripheral blood CD_(14)^(+)mononuclear cells and the pulmonary infection in esophageal cancer patients.METHODS Totally 262 esophageal cancer patients who underwent surgery in Huaihe Hospital of Henan University from Jan 2017 to Jan 2021 were recruited as the study subjects and divided into the infection group with 49 cases and the no infection group with 213 cases.The oropharyngeal florae were identified,the drug susceptibility testing was performed,the expression level of TLR4 in peripheral blood CD_(14)^(+)mononuclear cells was compared between the two groups of patients,and the influencing factors for the postoperative pulmonary infection in the esophageal cancer patients were observed.RESULTS The result of positive culture of bacteria was higher in the infection group than in the no infection group.All of gram-negative bacteria were highly resistant to ampicillin and piperacillin,while the drug resistance rate to imipenem was low.The drug resistance rates of Staphylococcus aureus and Staphylococcus haemolyticus to penicillin and amoxicillin were high,while the drug resistance rates to rifampicin and vancomycin were low.The percentage of positive TLR4 in peripheral blood CD_(14)^(+)mononuclear cells and MFI were higher in the infection group than in the no infection group(P<0.05).Multivariate analysis showed that the no less than 60 years of age,complication with diabetes mellitus,complication with chronic obstructive pulmonary disease(COPD)and history of smoking were the risk factors for the postoperative pulmonary infection in the esophageal cancer patients.CONCLUSION The esophageal cancer patients with postoperative pulmonary infection have oropharyngeal dysbacteriosis,the expression level of TLR4 in peripheral blood CD_(14)^(+)mononuclear cells is lower in the patients with infection than in the patients without infection.Therefore,it is necessary for the hospital to strengthen the postoperative oral hygiene,focus on

关 键 词：食管癌 肺部感染 口咽部菌群失调 外周血CD_(14)^(+)单核细胞 Toll样受体4 

分 类 号：R735.1[医药卫生—肿瘤]