胰腺癌术后继发腹腔感染危险因素及肠道菌群异位滋生和干扰素基因刺激蛋白与内毒素水平的关系  

Risk factors for postoperative secondary intra-abdominal infection in pancreatic cancer patients and association between ectopic breeding of intestinal flora, stimulator of interferon gene and endotoxin

作　　者：苟菲 贾洁 张天锋[1] 许晶[2] 鲁林微 程鹏[3] GOU Fei;JIA Jie;ZHANG Tian-feng;XU Jing;LU Lin-wei;CHENG Peng(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China)

机构地区：[1]南阳医学高等专科学校第一附属医院普通外科,河南南阳473000 [2]南京医科大学附属苏州科技城医院放疗科,江苏苏州215153 [3]南阳医学高等专科学校第一附属医院肿瘤科,河南南阳473000

出　　处：《中华医院感染学杂志》2023年第1期76-80,共5页Chinese Journal of Nosocomiology

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-12-43)。

摘　　要：目的 探究胰腺癌术后继发腹腔感染(IAI)危险因素,分析肠道菌群异位滋生、干扰素基因刺激蛋白(STING)、内毒素(ET)水平变化。方法 选取2017年5月-2021年5月南阳医学高等专科学校第一附属医院收治的行手术治疗的胰腺癌患者85例为研究对象,根据术后有无继发IAI分为感染组13例和非感染组72例,分析IAI危险因素及病原菌分布,比较两组肠道菌群(大肠埃希菌、乳酸杆菌、双歧杆菌、肠球菌)和STING、ET水平。结果 13例胰腺癌术后IAI患者共检出病原菌21株,其中革兰阴性菌12株、革兰阳性菌7株、真菌2株;单因素分析结果显示,合并糖尿病、血清白蛋白<35 g/L与胰腺癌术后继发腹腔感染有关(P<0.05),年龄、性别、BMI、TNM分期、手术时间、治疗方式、出血量与胰腺癌术后继发腹腔感染无关;多因素Logistic回归分析显示,合并糖尿病、血清白蛋白<35 g/L为胰腺癌术后继发IAI的独立危险因素(P<0.05);感染组大肠埃希菌、肠球菌及STING、ET水平高于非感染组,乳酸杆菌、双歧杆菌低于非感染组(P<0.05)。结论 胰腺癌术后继发IAI患者肠道菌群失调,STING mRNA、内毒素水平呈高表达,合并糖尿病、血清白蛋白<35 g/L是胰腺癌术后继发IAI的危险因素。OBJECTIVE To explore the risk factors for postoperative secondary intra-abdominal infection(IAI) in pancreatic cancer patients and observe the ectopic breeding of intestinal flora and changes of stimulator of interferon gene(STING) and endotoxin(ET). METHODS Totally 85 patients with pancreatic cancer who received surgical procedures in the First Affiliated Hospital of Nanyang Medical College from May 2017 to May 2021 were recruited as the study objects and were divided into the infection group with 13 cases and the no infection group with 72 cases according to the status of postoperative secondary IAI. The risk factors for IAI and distribution of pathogens were observed;the intestinal flora( Escherichia coli, Lactobacilli, Bifidobacteria, Enterococci), STING level and ET level were compared between the two groups. RESULTS A total of 21 strains of pathogens were isolated from 13 pancreatic cancer patients with postoperative IAI, 12 of which were gram-negative bacteria, 7 were gram-positive bacteria, and 2 were fungi. The result of univariate analysis showed that complication with diabetes mellitus and serum albumin less than 35g/L were associated with the postoperative secondary IAI in the pancreatic cancer patients(P<0.05). The age, gender, BMI, TNM stage, operation duration, treatment method and blood loss volume were not associated with the postoperative secondary IAI in the pancreatic cancer patients. Multivariate logistic regression analysis showed that the complication with diabetes mellitus and serum albumin level less than 35g/L were the independent risk factors for the postoperative secondary IAI in the pancreatic cancer patients. The levels of E. coli, Enterococci, STING and ET of the infection group were higher than those of the no infection group, while the Lactobacilli and Bifidobacteria of the infection group were lower than those of the no infection group(P<0.05). CONCLUSION The pancreatic cancer patients with postoperative secondary IAI show alteration of intestinal flora and high expressions of ST

关 键 词：胰腺癌 腹腔感染 肠道菌群异位滋生 刺激干扰素基因 内毒素 危险因素 

分 类 号：R619.3[医药卫生—外科学]