细胞免疫功能和炎性因子在结直肠癌患者根治术后并发切口感染中的价值研究
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摘要
目的探讨细胞免疫功能和炎性因子在结直肠癌患者根治术后并发切口感染中的价值。方法回顾性分析126例2015年2月至2017年5月期间在本院进行直肠癌根治术患者的临床资料,依据患者根治术后是否有切口感染分别为非感染组(65例)和感染组(61例),比较两组患者术前1天、术后当天及3天免疫细胞和炎性因子含量的差异。结果 (1)两组患者术前、术后当天和3天免疫细胞含量的比较与非感染组相比,感染组术前1天、术后当天和3天外周血中CD3~+CD4~+、CD3~+CD8~+、CD16~+CD56~+、CD19~+淋巴细胞含量均明显降低(均P<0.05)。同一组内与术前1天相比,术后当天、术后3天CD3~+CD4~+、CD3~+CD8~+、CD16~+CD56~+、CD19~+含量均显著降低(均P<0.05)。(2)两组患者术前、术后当天和3天炎性因子含量的比较与非感染组相比,感染组术前1天、术后当天和3天血清中hs-CRP、TNF-α、IL-1β、PCT、MCP-1量均明显升高(均P<0.05)。同一组内与术前1天相比,术后当天、3天hs-CRP、TNF-α、IL-1β、PCT、MCP-1含量均显著升高(均P<0.05)。结论围手术期细胞免疫功能和炎性因子状态在预测直肠癌患者根治术后并发切口感染具有重要价值,免疫功能低下、高炎性状态会增加直肠癌根治术后切口感染的风险,对于减少根治术后并发感染的治疗有一定的指导意义。
Objective To explore the value of cellular immune function and inflammatory factors in wound infection after radical resection of colorectal cancer patients.Methods Clinical data of 126 cases of patients with colorectal cancer radical during February2015 to May 2017 in our hospital were retrospectively analyzed and divided the infection group(65 cases)and infection group(61cases)on the basis of whether patients had a postoperative incision infection.The several immune cells and inflammatory factors at the time of 1 day before surgery,1 day and 3 day after surgery in the two groups were compared.Results(1)Comparison of immune cell contents before,the day after surgery and 3 days after operation between the two groups Compared with the non-infected group,the levels of CD3~+CD4~+,CD3~+CD8~+,CD16~+CD56~+and CD19~+in peripheral blood of the infected group 1 day before surgery,the day after surgery and 3 days after surgery were significantly reduced(all P<0.05).In the same group,the contents of CD3~+CD4~+,CD3~+CD8~+,CD16~+CD56~+and CD19~+were significantly reduced the day after surgery and 3 days after surgery compared with the day before surgery(all P<0.05).(2)Comparison of inflammatory cytokines between the two groups before,the day after surgery and 3days after operation Compared with the non-infected group,serum hs-CRP TNF-,IL-1β,PCT and MCP-1 levels were significantly increased on 1 day before surgery,the day after surgery and 3 days after surgery(all P<0.05).In the same group,the contents of hsCRP,TNF-α,IL-1β,PCT and MCP-1 were significantly increased the day after surgery(all P<0.05),compared with 1 day before surgery.Conclusion Perioperative cellular immune function and inflammatory factor status are of great value in predicting wound infection after radical resection of rectal cancer patients.Low immune function and high inflammatory status will increase the risk ofwound infection after radical resection of rectal cancer patients,which is of certain guiding significance for reducing the treatment of postoperative complicated infection after radical resection.
Objective To explore the value of cellular immune function and inflammatory factors in wound infection after radical resection of colorectal cancer patients.Methods Clinical data of 126 cases of patients with colorectal cancer radical during February2015 to May 2017 in our hospital were retrospectively analyzed and divided the infection group(65 cases)and infection group(61cases)on the basis of whether patients had a postoperative incision infection.The several immune cells and inflammatory factors at the time of 1 day before surgery,1 day and 3 day after surgery in the two groups were compared.Results(1)Comparison of immune cell contents before,the day after surgery and 3 days after operation between the two groups Compared with the non-infected group,the levels of CD3~+CD4~+,CD3~+CD8~+,CD16~+CD56~+and CD19~+in peripheral blood of the infected group 1 day before surgery,the day after surgery and 3 days after surgery were significantly reduced(all P<0.05).In the same group,the contents of CD3~+CD4~+,CD3~+CD8~+,CD16~+CD56~+and CD19~+were significantly reduced the day after surgery and 3 days after surgery compared with the day before surgery(all P<0.05).(2)Comparison of inflammatory cytokines between the two groups before,the day after surgery and 3days after operation Compared with the non-infected group,serum hs-CRP TNF-,IL-1β,PCT and MCP-1 levels were significantly increased on 1 day before surgery,the day after surgery and 3 days after surgery(all P<0.05).In the same group,the contents of hsCRP,TNF-α,IL-1β,PCT and MCP-1 were significantly increased the day after surgery(all P<0.05),compared with 1 day before surgery.Conclusion Perioperative cellular immune function and inflammatory factor status are of great value in predicting wound infection after radical resection of rectal cancer patients.Low immune function and high inflammatory status will increase the risk ofwound infection after radical resection of rectal cancer patients,which is of certain guiding significance for reducing the treatment of postoperative complicated infection after radical resection.
引文
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[10]刘盛楠,刘瑞,范婷婷,等.结直肠癌的诊断和治疗研究进展[J].山东医药,2017,57(40):110-112.
[11]陈功. 2017版美国国立综合癌症网络结直肠癌指南更新解读[J].中华胃肠外科杂志,2017,20(1):28-33.
[12]王耀辉,陈钰,高军,等.腹腔镜与开腹结直肠癌根治术后感染并发症的比较[J].中国微创外科杂志,2015,15(11):979-981.
[13]苗战军,韩宗明,朱鸿波,等.腹腔镜与开腹结直肠癌根治术围手术期并发症对比及原因分析[J].中国肿瘤外科杂志,2016,8(3):194-196.
[14]Elgazzaz G,Kiran R P,Lavery I. Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection[J]. Dis Colon Rectum. 2009,52(12):1962-6.
[15]Christian C K,Kwaan M R,Betensky R A,et al. Risk factors for perineal wound complications following abdominoperineal resection[J]. Dis Colon Rectum,2005,48(1):43-48.
[16]Lavotshkin S,Jalas J R,Torisu-Itakura H,et al. Immunoprofiling for prognostic asesment of colon cancer:a novel complement to ultrastaging[J]. J Gastrointest Surg,2015,19(6):999-1006.
[17]Sconocchia G,Eppenberger S,Spagnoli G C,et al. NK cels and T cells cooperate during the clinical course of colorectal cancer[J].Oncoimmunology,2014,3(8):e952197.
[18]傅华军,张少林,陈卉颖,等.结直肠癌术后切口感染与机体营养状态、免疫功能及炎性因子的关系[J].海南医学院学报,2017,23(7):921-924.
[19]陈建南,丁毅鹏.血浆脂联素TNF-α和IL-6在脓毒症鉴别诊断中的意义[J].中国急救医学,2016,36(12):1145-1147.
[20]熊真.不同严重程度溃疡性结肠炎炎症因子表达水平的临床研究[J].现代消化及介入诊疗,2016,21(3):423-425.
[21]郑超,乔陈财,陈奕,等.菌血症患者细菌感染程度与血清PCT、hs-CRP水平变化研究[J].重庆医科大学学报,2017,42(2):240-243.
[22]孙钦娟,李琴,宛东,等.细胞因子在炎症性肠病患者肠黏膜中表达的分析[J].胃肠病学,2018,23(1):13-17.
[2]González Nieves,Isabel P,Laura P N,et al. 2017 update on the relationship between diabetes and colorectal cancer:epidemiology,potential molecular mechanisms and therapeutic implications[J].Oncotarget,2017,8(11):18456-18485.
[3] Julien M,Dove J,Quindlen K,et al. Evolution of Laparoscopic Surgery for Colorectal Cancer:The Impact of the Clinical Outcomes of Surgical Therapy Group Trial[J]. Am Surg,2016,82(8):685-691.
[4]魏雨佳,闫超,孙克娟,等. 427例恶性肿瘤患者营养状况调查[J].肿瘤防治研究,2018,45(1):19-23.
[5]胡德升,董星,杨松鹏,等.术前营养不良对结直肠癌患者术后感染及免疫功能的影响[J].中华医院感染学杂志,2017,27(24):5626-5629.
[6]刘凯,马恒,张明星,等.胃癌围手术期营养风险和并发症影响因素分析[J].中华肿瘤防治杂志,2017,24(6):394-397.
[7]瞿永华. 47例腹腔镜结直肠癌根治术后护理体会[J].结直肠肛门外科,2016,22(S1),178.
[8]吴凯.低位直肠癌及其腹腔镜手术特殊性与预防性造口的选择[J].中国微创外科杂志,2017,17(9):832-835.
[9]邹大朋.直肠癌低位前切除术吻合口漏的防治体会[J].现代消化及介入诊疗,2015,20(1):30-32.
[10]刘盛楠,刘瑞,范婷婷,等.结直肠癌的诊断和治疗研究进展[J].山东医药,2017,57(40):110-112.
[11]陈功. 2017版美国国立综合癌症网络结直肠癌指南更新解读[J].中华胃肠外科杂志,2017,20(1):28-33.
[12]王耀辉,陈钰,高军,等.腹腔镜与开腹结直肠癌根治术后感染并发症的比较[J].中国微创外科杂志,2015,15(11):979-981.
[13]苗战军,韩宗明,朱鸿波,等.腹腔镜与开腹结直肠癌根治术围手术期并发症对比及原因分析[J].中国肿瘤外科杂志,2016,8(3):194-196.
[14]Elgazzaz G,Kiran R P,Lavery I. Wound complications in rectal cancer patients undergoing primary closure of the perineal wound after abdominoperineal resection[J]. Dis Colon Rectum. 2009,52(12):1962-6.
[15]Christian C K,Kwaan M R,Betensky R A,et al. Risk factors for perineal wound complications following abdominoperineal resection[J]. Dis Colon Rectum,2005,48(1):43-48.
[16]Lavotshkin S,Jalas J R,Torisu-Itakura H,et al. Immunoprofiling for prognostic asesment of colon cancer:a novel complement to ultrastaging[J]. J Gastrointest Surg,2015,19(6):999-1006.
[17]Sconocchia G,Eppenberger S,Spagnoli G C,et al. NK cels and T cells cooperate during the clinical course of colorectal cancer[J].Oncoimmunology,2014,3(8):e952197.
[18]傅华军,张少林,陈卉颖,等.结直肠癌术后切口感染与机体营养状态、免疫功能及炎性因子的关系[J].海南医学院学报,2017,23(7):921-924.
[19]陈建南,丁毅鹏.血浆脂联素TNF-α和IL-6在脓毒症鉴别诊断中的意义[J].中国急救医学,2016,36(12):1145-1147.
[20]熊真.不同严重程度溃疡性结肠炎炎症因子表达水平的临床研究[J].现代消化及介入诊疗,2016,21(3):423-425.
[21]郑超,乔陈财,陈奕,等.菌血症患者细菌感染程度与血清PCT、hs-CRP水平变化研究[J].重庆医科大学学报,2017,42(2):240-243.
[22]孙钦娟,李琴,宛东,等.细胞因子在炎症性肠病患者肠黏膜中表达的分析[J].胃肠病学,2018,23(1):13-17.