肺癌患者术后肺部感染sTREM-1和sCD163与PCT变化研究
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摘要
目的探讨肺癌术后肺部感染患者可溶性髓样细胞触发受体-1(sTREM-1)、可溶性血红蛋白清道夫受体(sCD163)、降钙素原(PCT)变化及感染病原菌,为肺癌术后肺部感染的诊断及治疗提供参考。方法选取2017年1-12月于医院治疗的肺癌术后发生肺部感染(设为感染组)与无肺部感染(设为无感染组)患者,各50例,以酶联免疫吸附法检测血sTREM-1、sCD163、PCT水平,对感染组患者痰液分离病原菌进行鉴定。结果感染组患者血sTREM-1、sCD163、PCT分别为(44.85±14.34)pg/ml、(123.48±54.95)pg/ml、(62.10±15.86)ng/ml高于无感染组(P<0.05);感染组感染控制后血sTREM-1、sCD163、PCT水平分别为(11.34±3.81)pg/ml、(85.22±31.12)pg/ml、(30.43±8.60)ng/ml,与感染控制前比较差异有统计学意义(P<0.05);感染组患者痰液共培养分离病原菌36株,其中革兰阴性菌25株占69.44%,革兰阳性菌9株占25.00%,真菌2株占5.56%,以肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌为主。结论肺癌术后肺部感染患者血sTREM-1、sCD163、PCT表现为升高,可为肺部感染的诊断提供参考,革兰阴性菌是引起肺癌患者术后肺部感染的主要病原菌。
OBJECTIVE To explore the changes of solusle triggerily re ceptor expressed on myecoid cel-1(sTREM-1), solusle hemoglobin scavenger receptor(sCD163), PCT and pathogens in lung cancer patients with operative pulmonary infection, so as to provide reference for the diagnosis and treatment of postoperative pulmonary infection in lung cancer patients. METHODS We selected 50 lung cancer patients with pulmonary infection(infection group) and 50 lung cancer patients without pulmonary infection(non-infection group) treated in the hospital from Jan. 2017-Dec. 2017. Blood levels of sTREM-1,sCD163 and PCT were detected by enzyme-linked immunosorbent assay(ELISA), and the pathogens isolated from sputum of patients in the infection group were identified. RESULTS The blood levels of sTREM-1, sCD163 and PCT were(44.85±14.34)pg/ml,(123.48±54.95)pg/ml, and(62.10±15.86)ng/ml respectively in the infection group, significantly higher than those of the non-infection group(P<0.05). The blood levels of sTREM-1, sCD163 and PCT were(11.34±3.81)pg/ml,(85.22±31.12)pg/ml, and(30.43±8.60)ng/ml in the infection group after infection control, and the difference was significant(P<0.05). 36 strains of pathogens were isolated from the infection group, including 25 strains of Gram-negative bacteria(69.44%), 9 strains of Gram-positive bacteria(25.00%), and 2 strains of fungi(5.56%). The dominant pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. CONCLUSION The significantly increased blood levels of sTREM-1, sCD163 and PCT in lung cancer patients with postoperative pulmonary infection can provide reference for the diagnosis of pulmonary infection. Gram-negative bacteria are the main cause of postoperative pulmonary infection in patients with lung cancer.
OBJECTIVE To explore the changes of solusle triggerily re ceptor expressed on myecoid cel-1(sTREM-1), solusle hemoglobin scavenger receptor(sCD163), PCT and pathogens in lung cancer patients with operative pulmonary infection, so as to provide reference for the diagnosis and treatment of postoperative pulmonary infection in lung cancer patients. METHODS We selected 50 lung cancer patients with pulmonary infection(infection group) and 50 lung cancer patients without pulmonary infection(non-infection group) treated in the hospital from Jan. 2017-Dec. 2017. Blood levels of sTREM-1,sCD163 and PCT were detected by enzyme-linked immunosorbent assay(ELISA), and the pathogens isolated from sputum of patients in the infection group were identified. RESULTS The blood levels of sTREM-1, sCD163 and PCT were(44.85±14.34)pg/ml,(123.48±54.95)pg/ml, and(62.10±15.86)ng/ml respectively in the infection group, significantly higher than those of the non-infection group(P<0.05). The blood levels of sTREM-1, sCD163 and PCT were(11.34±3.81)pg/ml,(85.22±31.12)pg/ml, and(30.43±8.60)ng/ml in the infection group after infection control, and the difference was significant(P<0.05). 36 strains of pathogens were isolated from the infection group, including 25 strains of Gram-negative bacteria(69.44%), 9 strains of Gram-positive bacteria(25.00%), and 2 strains of fungi(5.56%). The dominant pathogens were Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. CONCLUSION The significantly increased blood levels of sTREM-1, sCD163 and PCT in lung cancer patients with postoperative pulmonary infection can provide reference for the diagnosis of pulmonary infection. Gram-negative bacteria are the main cause of postoperative pulmonary infection in patients with lung cancer.
引文
[1] 刘志强,何斐,蔡琳.吸烟,被动吸烟与肺癌发病风险的病例对照研究[J].中华疾病控制杂志,2015,19(2):145-149.
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[12] 孙伟,王猛,李鑫,等.胸腔镜手术对肺癌患者术后感染及感染相关血清指标的影响研究[J].中华医院感染学杂志,2017,27(13):3010-3013.
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[14] Boffa DJ,Kosinski AS,Furnary AP,et al.Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy[J].J Clin Oncol,2018,36(23):2378-2385.
[15] 唐玉茹,李会,帅训军,等.保护性肺通气对老年肺癌患者肺叶切除术围术期肺功能的影响[J].中国医药导报,2017,14(20):120-124.
[16] Su L,Liu D,Chai W,et al.Role of sTREM-1 in predicting mortality of infection:a systematic review and meta-analysis[J].BMJ open,2016,6(5):e010314.
[17] Cao C,Gu J,Zhang J.Soluble triggering receptor expressed on myeloid cell-1 (sTREM-1):a potential biomarker for the diagnosis of infectious diseases[J].Front Med,2017,11(2):169-177.
[18] Dong L,Li L,Yan J.Effect of strem-1 on prognosis of patients with ventilator-associated pneumonia[J].Crit Care Med,2018,46(1):312.
[19] Altay FA,Elaldi N,Senturk GC,et al.Serum strem-1 level is quite higher in Crimean Congo hemorrhagic fever,a viral infection[J].J Med Virol,2016,88(9):1473-1478.
[20] 谢文君,朱莉艳,虞小芳,等.肺癌患者肺部感染的病原菌分布及血清中 NSE 和 CYFRA21-1 病理表达的临床研究[J].中华医院感染学杂志,2018,28(7):1008-1011.
[21] Suzuki Y,Enomoto Y,Yokomura K,et al.Soluble hemoglobin scavenger receptor CD163 (sCD163) predicts mortality of community-acquired pneumonia[J].J Infect,2016,73(4):375-377.
[22] Zhang Y,Ma Y,Zhang C,et al.Soluble scavenger receptor CD163 is associated with severe acute kidney injury in patients with Hantaan virus infection[J].Viral Immunol,2015,28(4):241-246.
[23] Wagner NM,Van Aken C,Butschkau A,et al.Procalcitonin impairs endothelial cell function and viability[J].Anesth Analg,2017,124(3):836-845.
[24] 靳生艳,黄文辉,王蓉,等.肺癌患者姑息治疗后肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(15):3392-3394.
[2] 许欢,林国桢,李科,等.广州市 2005-2013 年肺癌发病趋势分析[J].肿瘤预防与治疗,2017,30(2):112-115,126.
[3] Wang L,Li Y,Zhang X,et al.Characteristics of nosocomial infection and its effects on the survival of chemotherapy patients with advanced non-small cell lung cancer[J].Oncol Lett,2017,14(6):7379-7383.
[4] Curran T,Alvarez D,Pastrana Del Valle J,et al.Prophylactic closed‐incision negative‐pressure wound therapy is associated with decreased surgical site infection in high‐risk colorectal surgery laparotomy wounds[J].Colorectal Dis,2019,21(1):110-118.
[5] 冬兰,尹秋生.可溶性髓样细胞触发受体-1 在感染性疾病诊断中的作用[J].中华保健医学杂志,2015,17(1):72-73.
[6] 谢娟,张山,李梁,等.血清降钙素原,C 反应蛋白,可溶性髓细胞表达触发受体-1 及白细胞介素-6 对老年早发性脑卒中相关性肺炎的诊断价值[J].中国临床医学,2018,25(2):221-225.
[7] 梁迪,李道娟,师金,等.河北省 1973-2013 年恶性肿瘤死亡变化分析[J].中华流行病学杂志,2018,39(1):35-39.
[8] Keil AP,Richardson DB,Westreich D,et al.Estimating the impact of changes to occupational standards for silica exposure on lung cancer mortality[J].Epidemiology,2018,29(5):658-665.
[9] 宋振祥,胡晓冬,林韬,等.单孔胸腔镜手术治疗肺癌的研究现状及进展[J].临床肺科杂志,2017,22(3):557-559.
[10] Boffa DJ,Kosinski AS,Furnary AP,et al.Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy[J].J Clin Oncol,2018,36(23):2378-2385.
[11] Okada S,Shimada J,Teramukai S,et al.Risk stratification according to the prognostic nutritional index for predicting postoperative complications after lung cancer surgery[J].Ann Surg Oncol,2018,25(5):1254-1261.
[12] 孙伟,王猛,李鑫,等.胸腔镜手术对肺癌患者术后感染及感染相关血清指标的影响研究[J].中华医院感染学杂志,2017,27(13):3010-3013.
[13] Andrianaivoarimanana V,Bertherat E,Rajaonarison R,et al.Mixed pneumonic plague and nosocomial MDR-bacterial infection of lung:a rare case report[J].BMC Pulm Med,2018,18(1):92.
[14] Boffa DJ,Kosinski AS,Furnary AP,et al.Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy[J].J Clin Oncol,2018,36(23):2378-2385.
[15] 唐玉茹,李会,帅训军,等.保护性肺通气对老年肺癌患者肺叶切除术围术期肺功能的影响[J].中国医药导报,2017,14(20):120-124.
[16] Su L,Liu D,Chai W,et al.Role of sTREM-1 in predicting mortality of infection:a systematic review and meta-analysis[J].BMJ open,2016,6(5):e010314.
[17] Cao C,Gu J,Zhang J.Soluble triggering receptor expressed on myeloid cell-1 (sTREM-1):a potential biomarker for the diagnosis of infectious diseases[J].Front Med,2017,11(2):169-177.
[18] Dong L,Li L,Yan J.Effect of strem-1 on prognosis of patients with ventilator-associated pneumonia[J].Crit Care Med,2018,46(1):312.
[19] Altay FA,Elaldi N,Senturk GC,et al.Serum strem-1 level is quite higher in Crimean Congo hemorrhagic fever,a viral infection[J].J Med Virol,2016,88(9):1473-1478.
[20] 谢文君,朱莉艳,虞小芳,等.肺癌患者肺部感染的病原菌分布及血清中 NSE 和 CYFRA21-1 病理表达的临床研究[J].中华医院感染学杂志,2018,28(7):1008-1011.
[21] Suzuki Y,Enomoto Y,Yokomura K,et al.Soluble hemoglobin scavenger receptor CD163 (sCD163) predicts mortality of community-acquired pneumonia[J].J Infect,2016,73(4):375-377.
[22] Zhang Y,Ma Y,Zhang C,et al.Soluble scavenger receptor CD163 is associated with severe acute kidney injury in patients with Hantaan virus infection[J].Viral Immunol,2015,28(4):241-246.
[23] Wagner NM,Van Aken C,Butschkau A,et al.Procalcitonin impairs endothelial cell function and viability[J].Anesth Analg,2017,124(3):836-845.
[24] 靳生艳,黄文辉,王蓉,等.肺癌患者姑息治疗后肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26(15):3392-3394.