放化疗食管癌患者肺部感染危险因素及其预测模型构建  

Risk factors for pulmonary infection in esophageal cancer patients undergoing radiochemotherapy and establishment of prediction model

作　　者：李颖璐[1] 黄国胜[2] 时沛[1] 王建新[1] 崔瑶 LI Ying-lu;HUANG Guo-sheng;SHI Pei;WANG Jian-xin;CUI Yao(The First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473007,China)

机构地区：[1]南阳医学高等专科学校第一附属医院肿瘤内科,河南南阳473007 [2]南阳医学高等专科学校第一附属医院普胸外科,河南南阳473007

出　　处：《中华医院感染学杂志》2023年第17期2585-2589,共5页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191461)。

摘　　要：目的分析放化疗食管癌患者肺部感染危险因素,构建预测模型并对其预测价值进行分析。方法回顾性收集2018年3月-2022年4月南阳医学高等专科学校第一附属医院收治的382例放化疗食管癌患者的临床资料,根据患者是否发生肺部感染分为感染组41例和非感染组341例。分析感染病原菌分布,采用单因素和多因素Logistic回归分析放化疗食管癌患者肺部感染的危险因素,并据此构建预测模型,采用受试者工作特征(ROC)曲线分析其预测价值,观察感染后炎性因子水平变化。结果382例放化疗食管癌患者并发肺部感染41例,发生率为10.73%;共分离病原菌71株,其中革兰阴性菌48株,占67.61%;多因素Logistic回归分析结果显示,年龄≥60岁、有长期吸烟史和肿瘤位置为胸上段/中段为放化疗食管癌患者肺部感染的独立危险因素;将上述因素纳入Logistic回归分析,建立回归方程:Logit(P)=-4.509+年龄≥60岁×1.367+有长期吸烟史×1.628+肿瘤位置为胸上段/中段×0.987,经ROC曲线分析,当Logit(P)>13.58,曲线下面积(AUC)为0.941,敏感度为85.37%,特异度为87.98%;感染组患者白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)、降钙素原(PCT)水平均高于非感染组(P<0.05)。结论放化疗食管癌患者肺部感染病原菌以革兰阴性菌为主,其危险因素包括年龄、长期吸烟史、肿瘤位置等,据此构建的预测模型预测价值较高,同时肺部感染可导致炎性因子水平升高。OBJECTIVE To analyze the risk factors for pulmonary infection in the patients with esophageal cancer,establish the prediction model and analyze the predictive values.METHODS The clinical data were retrospectively collected from the 382 esophageal cancer patients who received radiochemotherapy in the First Affiliated Hospital of Nanyang Medical College from Mar 2018 to Apr 2022.The enrolled patients were divided into the infection group with 41 cases and the non-infection group with 341 cases according to the status of pulmonary infection.The distribution of pathogens isolated from the patients with infection was observed,univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the pulmonary infection in the esophageal cancer patients,the prediction model was established based on the risk factors,the predictive values were analyzed by means of receiver operating characteristic(ROC)curves,and the changes of inflammatory factors were observed after the patients had the infection.RESULTS Totally 41 patients had pulmonary infection among the 382 esophageal cancer patients undergoing radiochemotherapy,with the incidence rate 10.73%.Totally 71 strains of pathogens were isolated,48(67.61%)of which were gram-negative bacteria.The result of multivariate logistic regression analysis showed that the no less than 60 years of age,long history of smoking and tumor location at upper thoracic segment/middle thoracic segment were independent risk factors for the pulmonary infection in the esophageal cancer patients undergoing radiochemotherapy.The above indexes were included in the Logistic regression analysis to establish the regression equation:Logit(P)=-4.509+age≥60 years old×1.367+long-term smoking history×1.628+tumor location at upper thoracic segment/middle thoracic segment×0.987.ROC curve analysis showed that when the Logit(P)was greater than 13.58,the area under curve(AUC)was 0.941,with the sensitivity 85.37%,the specificity 87.98%.The levels of interleukin-1β(IL-1β),

关 键 词：食管癌 放化疗 肺部感染 病原菌 危险因素 预测模型 受试者工作特征曲线 

分 类 号：R563[医药卫生—呼吸系统]