血清ET、CEA、sTREM-1对胸腔镜肺癌根治术后肺部感染预测价值分析  

Analysis of the predictive value of serum ET,CEA,and sTREM⁃1 in pulmonary infection after thoracoscopic radical resection of lung cancer

作　　者：何开权 潘家东[1] 王军[1] 梁常凯 王国忠[1] 桂同城 汪秀航 HE Kaiquan;PAN Jiadong;WANG Jun;LIANG Changkai;WANG Guozhong;GUI Tongcheng;WANG Xiuhang(Department of Thoracic Surgery,Huoshan County Hospital,Lu'an,Anhui 237200,China)

机构地区：[1]霍山县医院胸外科,安徽六安237200

出　　处：《热带医学杂志》2025年第1期76-80,共5页Journal of Tropical Medicine

基　　金：安徽省中央引导地方科技发展专项资金项目(S202107d06020009)。

摘　　要：目的探讨血清内毒素(ET)、癌胚抗原(CEA)、可溶性髓系细胞触发受体-1(sTREM-1)与胸腔镜肺癌根治术后肺部感染的关系及其预测价值,为临床治疗提供参考依据。方法回顾性分析霍山县医院2022年8月-2023年8月125例肺癌且经胸腔镜肺癌根治术患者的临床资料,根据是否发生肺部感染(术后72 h内)分为感染组(n=30)和未感染组(n=95)。记录术后出现肺部感染患者的病原菌分布情况,分析术后肺部感染的危险因素,比较两组手术前及术后6 h血清ET、CEA、sTREM-1水平,使用受试者工作特性(ROC)曲线分析术后早期血清ET、CEA、sTREM-1及其联合检测对术后肺部感染的预测价值。结果30例胸腔镜术后出现肺部感染者中共检出42株病原菌,以革兰阴性菌为主(78.57%)。感染组与未感染组年龄(≥75岁)、合并肺部基础疾病、吸烟指数(≥400支/年)、病理分期(ⅢA期)、术前第1秒用力呼气容积占预计值百分比(FEV1pred)(<80%)、切除范围(联合肺叶切除)、术后入住ICU人数差异均有统计学意义(P均<0.05)。Logistic回归分析显示,年龄≥75岁、吸烟指数≥400支/年、病理分期为ⅢA期、术前FEV1pred<80%、切除范围为联合肺叶、术后入住ICU是影响肺癌胸腔镜术后肺部感染的危险因素(P均<0.05)。感染组患者术后6 h血清ET、CEA、sTREM-1水平均高于未感染组,差异均有统计学意义(t=16.607、4.102、9.876,P均<0.05)。ROC曲线分析显示,血清ET、CEA、sTREM-1及指标联合预测概率曲线下面积(AUC)分别为0.884(95%CI:0.815~0.935)、0.792(95%CI:0.711~0.860)、0.838(95%CI:0.764~0.897)、0.947(95%CI:0.891~0.979),且单一因素AUC均低于联合预测概率(Z_(ET vs.联合)=1.989、Z_(CEA vs.联合)=2.872、Z_(sTREM-1 vs.联合)=2.257,P均<0.05)。结论高龄、吸烟较多、病理分期高、术前肺功能较差、联合肺叶切除及术后入住ICU均为引起胸腔镜肺癌根治术后肺部感染的危险因素,术后早期检测血清ET、CEObjective To investigate the relationship and predictive value of serum endotoxin(ET),carcinoembryonic antigen(CEA),soluble myeloid cell triggering receptor-1(sTREM-1),and pulmonary infection after thoracoscopic lung cancer radical surgery.Methods A retrospective analysis was conducted on the clinical data of 125 lung cancer patients who underwent thoracoscopic radical surgery for lung cancer in hospitals from August 2022 to August 2023.They were divided into an infected group(n=30)and an uninfected group(n=95)based on whether they experienced lung infection 72 hours after surgery.The distribution of pulmonary infection pathogens was recorded;logistic regression was used to analyze the risk factors of pulmonary infection after thoracoscopic lung cancer radical surgery;the differences in serum ET,CEA,and sTREM-1 levels between the two groups before and 6 hours after surgery were compared;the receiver operating characteristic(ROC)curve was used to analyze the predictive value of early postoperative serum ET,CEA,sTREM-1,and their combined detection for postoperative pulmonary infection.Results A total of 42 strains of pathogenic bacteria were detected in 30 patients with pulmonary infection after thoracoscopic surgery,with gram negative bacteria being the main pathogen(78.57%).There were significant differences in age(≥75 years),concomitant lung diseases,smoking index(≥400cigarettes/year),pathological stage(ⅢA),preoperative forced expiratory volume in 1 second as a percentage of predicted value(FEV1pred)(<80%),resection range(multiple lobes),and number of people admitted to ICU after surgery between the infection group and the non-infection group(all P<0.05).Logistic regression analysis showed that age≥75 years,smoking index≥400 cigarettes/year,pathological stageⅢA,preoperative FEV1pred<80%,resection range of multiple lobes,and postoperative ICU admission were risk factors for postoperative pulmonary infection after thoracoscopic lung cancer surgery(P<0.05).The serum ET,CEA,and sTREM-1 levels of patients

关 键 词：肺癌 内毒素 癌胚抗原 可溶性髓系细胞触发受体-1 

分 类 号：R734.2[医药卫生—肿瘤]