血清白细胞介素-6和C反应蛋白升高预测直肠癌术后早期发生吻合口瘘的对比研究  

Comparative study on the prediction of early postoperative anastomotic leakage in rectal cancer patients with elevated serum interleukin-6 and C-reactive protein levels

作　　者：王柯 李志萍 尚震月 李瑞欣 Wang Ke;Li Zhiping;Shang Zhenyue;Li Ruixin(Department of Surgical Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院外科医学部,郑州450052

出　　处：《中华实验外科杂志》2023年第11期2327-2330,共4页Chinese Journal of Experimental Surgery

摘　　要：目的:探索接受直肠癌根除术的患者在术后早期发生吻合口瘘(AL)的风险因素,并评估炎性因子C反应蛋白(CRP)以及白细胞介素-6(IL-6)对术后AL的预测价值。方法:本研究纳入74例2021年8月至2023年5月在郑州大学第一附属医院行直肠癌根除术治疗的直肠癌患者。所有病例在术前1 d以及术后第1、2、3天采集空腹腔静脉血样并通过酶联免疫吸附法(ELISA)检测血清IL-6和CRP的水平。收集所有患者人口统计学和临床统计数据,并采用SPSS 25.0统计软件进行分析,两组之间的比较采用Student’s t检验以及卡方检验。对直肠癌患者术后发生AL的危险因素进行逻辑回归分析。结果:与非AL组比较,AL组患者在术中发生低体温的比例更高(22.2%比5.4%,χ^(2)=11.863,P<0.05)。此外,发生AL的患者术前营养指标血红蛋白(Hb)(98.0±12.5)g/L比(115.0±11.6)g/L(t=5.536,P<0.05)以及白蛋白(ALB)水平(34.3±8.2)g/L比(40.5±7.6)g/L(t=4.788,P<0.01)均显著低于非AL组的患者。AL组患者在术后第1天的CRP(1523.56±288.23)pg/ml比(1337.24±214.63)pg/ml(t=3.335,P<0.01)、IL-6(21.56±4.48)pg/ml比(18.77±3.32)pg/ml(t=4.371,P<0.01),第2天的CRP(1447.56±257.89)pg/ml比(1288.33±199.86)pg/ml(t=4.889,P<0.01)、IL-6(20.22±3.34)pg/ml比(16.33±4.55)pg/ml(t=7.257,P<0.01)以及第3天的CRP(1334.55±212.33)pg/ml比(1211.45±223.56)pg/ml(t=3.321,P<0.01)、IL-6(17.22±4.41)pg/ml比(15.11±2.88)pg/ml(t=5.518,P<0.01)水平均显著高于非AL组。血清CRP联合IL-6诊断AL的效果最好,截断面积为0.899,敏感性87.2%,特异性82.3%。结论:本研究结果显示,术前ALB水平降低、术中低体温、术后第1天CRP水平升高以及术后第1天IL-6水平升高是直肠癌患者早期发生AL的危险因素。Objective To explore the risk factors for early anastomotic leakage(AL)in patients undergoing radical resection for colorectal cancer and evaluate the predictive value of inflammatory factors C-reactive protein(CRP)and interleukin-6(IL-6)for postoperative AL.Methods This study included 74 patients with colorectal cancer who underwent radical resection at our hospital from August 2021 to May 2023.Fasting venous blood samples were collected from all cases 1 day before surgery,as well as 1,2,and 3 days after surgery,and the levels of serum IL-6 and CRP were measured using enzyme-linked immunosorbent assay(ELISA).Demographic and clinical data were collected for all patients,and data analysis was performed using SPSS 25.0 software(IBM,Armonk,NY,USA),and Student’s t-test as well as chi-square test were used for the comparison between the two groups.Logistic regression analysis was performed to analyze the risk factors for the development of AL in colorectal cancer patients after surgery.Results Compared to the non-AL group,the AL group had a higher incidence of intraoperative hypothermia(22.2%vs.5.4%,χ^(2)=11.863,P<0.05).Furthermore,patients who developed AL had significantly lower preoperative nutritional indicators,including hemoglobin(Hb)levels[(98.0±12.5)g/L vs.(115.0±11.6)g/L,t=5.536,P<0.05]and albumin(ALB)levels[(34.3±8.2)g/L vs.(40.5±7.6)g/L,t=4.788,P<0.01],compared to the non-AL group.In the AL group,the levels of CRP on the first postoperative day[(1523.56±288.23)pg/ml vs.(1337.24±214.63)pg/ml,t=3.335,P<0.01]and IL-6[(21.56±4.48)pg/ml vs.(18.77±3.32)pg/ml,t=4.371,P<0.01]were significantly higher than those in the non-AL group.On the second postoperative day,the levels of CRP[(1447.56±257.89)pg/ml vs.(1288.33±199.86)pg/ml,t=4.889,P<0.01]and IL-6[(20.22±3.34)pg/ml vs.(16.33±4.55)pg/ml,t=7.257,P<0.01]were also significantly higher in the AL group compared to the non-AL group.Similarly,on the third postoperative day,the levels of CRP[(1334.55±212.33)pg/ml vs.(1211.45±223.56)pg/ml,t=3.321,P<0.01]an

关 键 词：吻合口瘘 直肠癌 炎性因子 风险因素 

分 类 号：R735.37[医药卫生—肿瘤]