食管癌术后并发肺部感染危险因素和预测模型构建  

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

作　　者：吕明闯[1] 曹睿 丁旭青[1] 李国梁[1] 陈基升 LYU Ming-chuang;CAO Rui;DING Xu-qing;LI Guo-liang;CHEN Ji-sheng(Nanyang Second People's Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市第二人民医院胸外科,河南南阳473000

出　　处：《中华医院感染学杂志》2024年第10期1507-1511,共5页Chinese Journal of Nosocomiology

基　　金：2022年河南省联合共建项目(LHGJ20221046)。

摘　　要：目的探讨食管癌术后并发肺部感染的病原菌分布及危险因素,并构建风险预测模型,评估其预测价值。方法以2018年5月-2022年12月南阳市第二人民医院收治的169例食管癌手术患者为研究对象,其中并发肺部感染52例为感染组,未并发肺部感染117例为未感染组,统计食管癌术后并发肺部感染患者的病原菌分布特点,采用多因素Logistic回归筛选危险因素,并构建风险预测模型,受试者工作特征(ROC)曲线和校准曲线评估模型的预测价值。结果52例并发肺部感染患者共检出61株病原菌,其中以革兰阴性菌为主(37株,60.66%);多因素Logistic回归分析结果显示,肿瘤部位为上/中段、有吸烟史、合并糖尿病及外周血Toll样受体-4(TLR4)、核因子-κB(NF-κB)mRNA水平偏高与食管癌术后并发肺部感染有关(P<0.05);构建的预测模型经Hosmer-Lemeshow拟合度检验结果显示,模型拟合的准确度较好(χ^(2)=6.214,P=0.623),校准曲线发现,模型区分、校准和预测能力良好;ROC曲线结果显示,曲线下面积(AUC)值为0.880(95%CI为0.822~0.938)、模型诊断的灵敏度为75.00%,特异度为87.18%。结论食管癌术后并发肺部感染的病原菌以革兰阴性菌为主,且其发生与肿瘤部位为上/中段、有吸烟史、合并糖尿病及TLR4/NF-κB信号通路变化有关,据此建立的风险预测模型具有较高的准确度及区分度。OBJECTIVE To explore the distribution of pathogens and risk factors for pulmonary infection in the patients with esophageal cancer,establish the risk prediction model and evaluate the predictive value.METHODS Totally 169 patients with esophageal cancer who received surgical procedures in Nanyang Second People′s Hospital from May 2018 to Dec 2022 were recruited as the research subjects,52 of whom were complicated with pulmonary infection and were assigned as the infection group,117 were not complicated with pulmonary infection and were assigned as the no infection group.The distribution of pathogens isolated from the esophageal cancer patients complicated with pulmonary infection was statistically analyzed.Multivariate logistic regression analysis was performed for the risk factors,the risk prediction model was established,and the predictive value of the model was evaluated by means of receiver operating characteristic(ROC)curves and calibration curves.RESULTS Totally 61 strains of pathogens were isolated from 52 patients complicated with pulmonary infection,37(60.66%)of which were gram-negative bacteria.The result of multivariate logistic regression analysis showed that upper/middle site of tumor,smoking history,complication with diabetes mellitus and high levels of peripheral blood TLR4 and NF-κB mRNA were associated with the postoperative pulmonary infection in the esophageal cancer patients(P<0.05).The result of Hosmer-Lemeshow test of goodness of fit indicated that the model has favorable fitting accuracy(χ^(2)=6.214,P=0.623),the calibration curves showed that the model had favorable capabilities of differentiation,calibration and prediction.The result of ROC curve analysis indicated that the area under curve(AUC)was 0.880(95%CI 0.822-0.938),the sensitivity of the model was 75%in diagnosis,with the specificity 87.18%.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the esophageal cancer patients with postoperative pulmonary infection,and the incidence of the infection i

关 键 词：食管癌 肺部感染 病原菌 TOLL样受体-4 核因子-ΚB 信号通路 

分 类 号：R735.1[医药卫生—肿瘤]