甲泼尼龙对行新辅助化疗联合免疫治疗局部晚期食管癌患者术后肺部感染的预防效果  

Efficacy of methylprednisolone in preventing postoperative pulmonary infections in locally advanced esophageal cancer patients undergoing neoadjuvant chemotherapy combined with immunotherapy

作　　者：谷城威 齐博[1,2] 唐家萍 霍书华 刘玉珍[1,2,3] 赵宝生 GU Chengwei;QI Bo;TANG Jiaping;HUO Shuhua;LIU Yuzhen;ZHAO Baosheng(Department of Thoracic Surgery,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China;Esophageal Cancer Institute,Xinxiang Medical University,Weihui 453100,Henan Province,China;Life Science Research Center,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)

机构地区：[1]新乡医学院第一附属医院胸外科,河南卫辉453100 [2]新乡医学院食管癌研究所,河南卫辉453100 [3]新乡医学院第一附属医院生命科学研究中心,河南卫辉453100

出　　处：《新乡医学院学报》2024年第8期744-749,共6页Journal of Xinxiang Medical University

基　　金：河南省科技厅科技攻关计划项目(编号:242102311124);河南省医学科技攻关省部共建重点项目(编号:SBGJ202102188)。

摘　　要：目的探讨甲泼尼龙对行辅助化疗联合免疫治疗的局部晚期食管癌患者术后肺部感染的预防效果。方法选择2022年1月至2023年12月新乡医学院第一附属医院收治的89例局部晚期食管癌患者为研究对象,所有患者行胸腹腔镜联合食管癌根治术。采用随机数字表法将患者分为观察组(n=45)和对照组(n=44),观察组有1例术中中转开胸、2例胸腔广泛粘连、1例术前合并上呼吸道感染被排除,对照组有1例胸腔广泛粘连、1例术前合并上呼吸道感染被排除,本研究共纳入83例研究对象,观察组和对照组分别为41例和42例。术前2组患者均给予白蛋白结合型紫杉醇+奈达铂联合卡瑞利珠单抗新辅助治疗方案2周期。术后对照组患者接受抗感染常规治疗,观察组患者于术后第1天至第3天,每日静脉滴注甲泼尼龙1 mg·kg^(-1)。比较2组患者术后炎症指标、术后肺部感染发生率、吻合口瘘发生率、术后住院时间、住院总花费情况。结果术前,2组患者白细胞计数、中性粒细胞比例、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)水平比较差异无统计学意义(P>0.05)。术后1、4 d,观察组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著高于术前(P<0.05),术后4 d患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著低于术后1 d(P<0.05)。术后1、4 d,对照组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著高于术前(P<0.05),术后4 d白细胞计数、中性粒细胞比例和hs-CRP水平显著低于术后1 d(P<0.05);术后4 d与术后1 d患者PCT和IL-6水平比较差异无统计学意义(P>0.05)。术后1 d,观察组与对照组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平比较差异无统计学意义(P>0.05);术后4 d,观察组患者白细胞、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著低于对照组(P<0.05)。对照组与观察组患�Objective To investigate the efficacy of methylprednisolone in preventing postoperative pulmonary infections in locally advanced esophageal cancer patients undergoing neoadjuvant chemotherapy combined with immunotherapy.Methods A total of 89 patients with locally advanced esophageal cancer treated at the First Affiliated Hospital of Xinxiang Medical University from January 2022 to December 2023 were selected as the research subjects.All patients underwent thoracolaparoscopic radical esophagectomy for esophageal cancer.The patients were randomly divided into an observation group(n=45)and a control group(n=44)using a random number table method.In the observation group,one patient with intraoperative thoracotomy,two patients with extensive pleural adhesion,and one patient with preoperative upper respiratory tract infection were excluded.In the control group,one patient with extensive pleural adhesion and one patient with preoperative upper respiratory tract infection were excluded.As a result,a total of 83 patients were included in the study,with 41 in the observation group and 42 in the control group.Preoperatively,a neoadjuvant treatment regimen of paclitaxel(albumin-bound)+nedaplatin in combination with camrelizumab was given to patients in both groups for 2 cycles.Patients in the control group received conventional anti-infection treatment after surgery,while patients in the observation group were intravenously injected with methylprednisolone at a dose of 1 mg·kg^(-1) daily from the first to the third day after surgery.Postoperative inflammatory markers,incidence of postoperative pulmonary infections,incidence of anastomotic fistula,postoperative hospital stay,and total hospitalization costs were compared between the two groups.Results There were no statistically significant differences in leukocyte count,neutrophil ratio,procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),and interleukin-6(IL-6)levels of patients between the two groups before treatment(P>0.05).On day 1 and 4 after treatment,patient

关 键 词：甲泼尼龙 食管癌 新辅助化疗 肺部感染 炎症因子 吻合口瘘 

分 类 号：R735.1[医药卫生—肿瘤]