老年结直肠癌患者术后肺部感染对RAAS的影响及其机制研究
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摘要
目的分析老年结直肠癌患者术后肺部感染对机体免疫功能以及肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法选取2015年2月-2018年3月在医院胃肠外科接受结直肠癌手术治疗的老年患者为研究对象。术后肺部感染的42例患者纳入感染组,术后未发生肺部感染的患者45例纳入非感染组。对比分析两组患者机体免疫功能指标[CD_3~+、CD_4~+、CD_8~+、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、胰岛素样生长因子I(IGF-I)]和RAAS指标[肾素(NE)、血管紧张素Ⅱ(AngⅡ)、血管紧张素原(AGT)、醛固酮(ALD)]差异。结果感染组患者外周血中T淋巴细胞亚群水平低于非感染组。同时,炎症因子、RAAS指标的水平均高于非感染组的患者,差异具有统计学意义(P<0.05)。结论老年结直肠癌患者术后肺部感染造成RAAS系统激素水平升高,不利于术后康复。
OBJECTIVE To observe the influence of postoperative pulmonary infection on immune function and renin-angiotensin-aldosterone system(RAAS) of elderly patients with colorectal cancer. METHODS The elderly patients with colorectal cancer who were treated in gastrointestinal surgery department from Feb 2015 to Mar 2018 were recruited as the study objects, 42 patients who had postoperative pulmonary infection were assigned as the infection group, and 45 patients who did not have postoperative pulmonary infection were set as the non-infection group. The levels of immune function indexes CD_3~+, CD_4~+, CD_8~+, interleukin-6(IL-6), tumor necrosis factor α(TNF-α)and insulin-like growth factor I(IGF-I)as well as RAAS indexes renin(NE), angiotensinⅡ(AngⅡ), angiotensinogen(AGT) and aldosterone(ALD) were observed and compared between the two groups of patients. RESULTS The levels of peripheral blood T lymphocyte subsets of the infection group were lower than those of the non-infection group. The levels of RAAS indexes of the infection group were significantly higher than those of the non-infection group(P<0.05). CONCLUSION The postoperative pulmonary infection in the elderly patients with colorectal cancer,may lead to the elevated levels of hormones in the RAAS, which is even more detrimental to postoperative recovery.
OBJECTIVE To observe the influence of postoperative pulmonary infection on immune function and renin-angiotensin-aldosterone system(RAAS) of elderly patients with colorectal cancer. METHODS The elderly patients with colorectal cancer who were treated in gastrointestinal surgery department from Feb 2015 to Mar 2018 were recruited as the study objects, 42 patients who had postoperative pulmonary infection were assigned as the infection group, and 45 patients who did not have postoperative pulmonary infection were set as the non-infection group. The levels of immune function indexes CD_3~+, CD_4~+, CD_8~+, interleukin-6(IL-6), tumor necrosis factor α(TNF-α)and insulin-like growth factor I(IGF-I)as well as RAAS indexes renin(NE), angiotensinⅡ(AngⅡ), angiotensinogen(AGT) and aldosterone(ALD) were observed and compared between the two groups of patients. RESULTS The levels of peripheral blood T lymphocyte subsets of the infection group were lower than those of the non-infection group. The levels of RAAS indexes of the infection group were significantly higher than those of the non-infection group(P<0.05). CONCLUSION The postoperative pulmonary infection in the elderly patients with colorectal cancer,may lead to the elevated levels of hormones in the RAAS, which is even more detrimental to postoperative recovery.
引文
[1] 蒋丽萍,吴煌福,何贵省.老年结直肠癌腹腔镜手术患者术后肠梗阻发生率及影响因素[J].中国老年学杂志,2018,38(6):1338-1341.
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[8] 古忆,周建松,夏思良,等.阿托伐他汀对慢性心力衰竭RAAS系统与炎性因子的影响[J].临床心血管病杂志,2016,32(1):94-96.
[9] Liesenfeld DB,Grapov D,Fahrmann JF,et al.Metabolomics and transcriptomics identify pathway differences between visceral and subcutaneous adipose tissue in colorectal cancer patients:the ColoCare study[J].Am J Clin Nutr,2015,102(2):433-443.
[10] 单汉民,徐文丽,刘洋,等.不同麻醉方案下结直肠癌患者的肺部感染状况对比[J].中华医院感染学杂志,2017,27(7):1590-1593.
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[12] Brugts JJ,van Vark L,Akkerhuis M,et al.Impact of renin-angiotensin system inhibitors on mortality and major cardiovascular endpoints in hypertension:a number-needed-to-treat analysis[J].Int J Cardiol,2015,181:425-429.
[13] Liesenfeld DB,Habermann N,Toth R,et al.Changes in urinary metabolic profiles of colorectal cancer patients enrolled in a prospective cohort study (ColoCare)[J].Metabolomics,2015,11(4):998-1012.
[14] Abron JD,Singh NP,Murphy AE,et al.Differential role of CXCR3 in inflammation and colorectal cancer[J].Oncotarget,2018,9(25):17928-17936.
[15] 黄文辉,林龙,侯开庆.老年结直肠癌患者开放性与腹腔镜手术近期疗效及术后并发症对比[J].中国老年学杂志,2017,37(14):3515-3517.
[16] Chen L,Wang S,Wang Y,et al.IL-6 influences the polarization of macrophages and the formation and growth of colorectal tumor[J].Oncotarget,2018,9(25):17443-17454.
[17] 刘文文,喻婷,刘佳,等.感染评分及小野寺指数在老年结直肠癌术后感染及预后评估中的应用价值[J].中华医院感染学杂志,2017,27(8):1814-1817.
[18] Griffiths SV,Conway DH,POPC-CB Investigators,et al.What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients[J].Perioper Med (Lond),2018,7:7.
[19] Kocarnik JM,Chan AT,Slattery ML,et al.Relationship of prediagnostic body mass index with survival after colorectal cancer:stage-specific associations[J].Int J Cancer,2016,139(5):1065-1072.
[20] 唐东辉,侯玉洁,白爽,等.运动结合饮食控制通过降低RAAS系统活性改善男性肥胖青少年血管内皮功能[J].体育科学,2017,37(9):48-54.
[21] Romero CA,Orias M,Weir MR.Novel RAAS agonists and antagonists:clinical applications and controversies[J].Nat Rev Endocrinol,2015,11(4):242-252.
[22] Rodriguez-Larrad A,Vellosillo-Ortega JM,Ruiz-Muneta C,et al.Postoperative respiratory exercises reduce the risk of developing pulmonary complications in patients undergoing lobectomy[J].Arch Bronconeumol,2016,52(7):347-353.
[23] 邢晓莉,曾妮,张节平,等.老年心力衰竭患者肺部感染的病原菌分布及对血清降钙素原水平的影响研究[J].中华医院感染学杂志,2018,28(14):2097-2100.
[24] 陈翔,陆宝华,袁杰,等.老年结直肠癌血清可溶性细胞间黏附分子-1及炎性因子表达的临床意义[J].重庆医学,2016,45(16):2202-2204.
[2] 杨勇,陈小杰,陈仁雄,等.结直肠癌患者术后肺部并发症的危险因素[J].实用医学杂志,2017,33(3):405-407.
[3] Delphan M,Lin T,Liesenfeld DB,et al.Associations of branched-chain amino acids with parameters of energy balance and survival in colorectal cancer patients:results from the ColoCare study[J].Metabolomics,2018,2018(14):22.
[4] Lustgarten MS,Price LL,Chale A,et al.Branched chain amino acids are associated with muscle mass in functionally limited olderadults[J].J Gerontol A Biol Sci Med Sci,2014,69(6):717-724.
[5] 任承纲,刘丹,李艳红,等.老年结直肠癌患者手术部位感染及相关因素分析[J].中国感染与化疗杂志,2016,16(4):424-428.
[6] Vandeputte C,Kehagias P,El Housni H,et al.Circulating tumor DNA in early response assessment and monitoring of advanced colorectal cancer treated with a multi-kinase inhibitor[J].Oncotarget,2018,9(25):17756-17769.
[7] Malietzis G,Aziz O,Bagnall NM,et al.The role of body composition evaluation by computerized tomography in determining colorectal cancer treatment outcomes:a systematic review[J].Eur J Surg Oncol,2015,41(2):186-196.
[8] 古忆,周建松,夏思良,等.阿托伐他汀对慢性心力衰竭RAAS系统与炎性因子的影响[J].临床心血管病杂志,2016,32(1):94-96.
[9] Liesenfeld DB,Grapov D,Fahrmann JF,et al.Metabolomics and transcriptomics identify pathway differences between visceral and subcutaneous adipose tissue in colorectal cancer patients:the ColoCare study[J].Am J Clin Nutr,2015,102(2):433-443.
[10] 单汉民,徐文丽,刘洋,等.不同麻醉方案下结直肠癌患者的肺部感染状况对比[J].中华医院感染学杂志,2017,27(7):1590-1593.
[11] 凌宝存.手术后肺部并发症[M].北京:人民卫生出版社,1994:12-16.
[12] Brugts JJ,van Vark L,Akkerhuis M,et al.Impact of renin-angiotensin system inhibitors on mortality and major cardiovascular endpoints in hypertension:a number-needed-to-treat analysis[J].Int J Cardiol,2015,181:425-429.
[13] Liesenfeld DB,Habermann N,Toth R,et al.Changes in urinary metabolic profiles of colorectal cancer patients enrolled in a prospective cohort study (ColoCare)[J].Metabolomics,2015,11(4):998-1012.
[14] Abron JD,Singh NP,Murphy AE,et al.Differential role of CXCR3 in inflammation and colorectal cancer[J].Oncotarget,2018,9(25):17928-17936.
[15] 黄文辉,林龙,侯开庆.老年结直肠癌患者开放性与腹腔镜手术近期疗效及术后并发症对比[J].中国老年学杂志,2017,37(14):3515-3517.
[16] Chen L,Wang S,Wang Y,et al.IL-6 influences the polarization of macrophages and the formation and growth of colorectal tumor[J].Oncotarget,2018,9(25):17443-17454.
[17] 刘文文,喻婷,刘佳,等.感染评分及小野寺指数在老年结直肠癌术后感染及预后评估中的应用价值[J].中华医院感染学杂志,2017,27(8):1814-1817.
[18] Griffiths SV,Conway DH,POPC-CB Investigators,et al.What are the optimum components in a care bundle aimed at reducing post-operative pulmonary complications in high-risk patients[J].Perioper Med (Lond),2018,7:7.
[19] Kocarnik JM,Chan AT,Slattery ML,et al.Relationship of prediagnostic body mass index with survival after colorectal cancer:stage-specific associations[J].Int J Cancer,2016,139(5):1065-1072.
[20] 唐东辉,侯玉洁,白爽,等.运动结合饮食控制通过降低RAAS系统活性改善男性肥胖青少年血管内皮功能[J].体育科学,2017,37(9):48-54.
[21] Romero CA,Orias M,Weir MR.Novel RAAS agonists and antagonists:clinical applications and controversies[J].Nat Rev Endocrinol,2015,11(4):242-252.
[22] Rodriguez-Larrad A,Vellosillo-Ortega JM,Ruiz-Muneta C,et al.Postoperative respiratory exercises reduce the risk of developing pulmonary complications in patients undergoing lobectomy[J].Arch Bronconeumol,2016,52(7):347-353.
[23] 邢晓莉,曾妮,张节平,等.老年心力衰竭患者肺部感染的病原菌分布及对血清降钙素原水平的影响研究[J].中华医院感染学杂志,2018,28(14):2097-2100.
[24] 陈翔,陆宝华,袁杰,等.老年结直肠癌血清可溶性细胞间黏附分子-1及炎性因子表达的临床意义[J].重庆医学,2016,45(16):2202-2204.