肝癌TACE术后感染的危险因素及血清IL-8与CRP和PCT对感染的诊断价值
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摘要
目的探究肝癌患者肝动脉化疗栓塞术(TACE)术后感染的危险因素,分析血清白介素-8(IL-8)、C-反应蛋白(CRP)、降钙素原(PCT)指标对感染的诊断价值。方法选择医院2017年1月～2018年6月收治的248例肝癌患者为研究对象,39例感染患者作为感染组,未发生感染209例为未感染组。单因素及多因素非条件Logistic回归分析肝癌TACE术后感染的危险因素,观察患者血清IL-8、CRP、PCT指标对感染的诊断价值。结果感染组和未感染组患者性别、年龄、肝功能分级、肿瘤大小、TACE次数、门静脉癌栓、门脉高压比较差异无统计学意义;多因素Logistic回归分析,腹水、碘油剂量、肝脓肿史、肝癌破裂出血为肝癌TACE术后感染的独立危险因素。两组患者总胆红素、谷草转氨酶、谷丙转氨酶、血小板及白细胞水平比较差异无统计学意义,感染组IL-8、CRP及PCT指标水平高于未感染组(P<0.05);IL-8、CRP及PCT指标联合检测曲线下面积为0.946,明显高于单个指标。结论肝癌TACE术后感染的发生和多种高危因素有关,其中IL-8、CRP及PCT对其诊断有一定价值,可为临床肝癌TACE术后感染的防治进行医学干预并制定策略提供依据。
OBJECTIVE To explore the risk factors for postoperative infection in liver cancer patients undergoing transcatheter arterial chemoembolization(TACE)analyze the value of serum interleukin-8(IL-8),C-reactive protein(CRP)and procalcitonin(PCT)in diagnosis of infection.METHODS A total of 248 liver cancer patients who were treated in the hospital from Jan 2017 to Jun 2018 were recruited as the study objects,39 patients who had infection were assigned as the infection group,and 209 patients who did not have infection were set as the non-infection group.Univariate analysis and non-conditional multivariate logistic regression analysis were performed for risk factors for the postoperative infection in the patients undergoing TACE,and the value of serum IL-8,CRP and PCT in diagnosis of the infection was observed.RESULTS There were no significant differences in the gender,age,grade of liver function,size of tumor,number of times of TACE,portal vein thrombosis and portal hypertension between the infection group and the non-infection group.The multivariate logistic regression analysis showed that ascites,dosage of iodipin,history of liver abscess and rupture and hemorrhage of liver cancer were the independent risk factors for the postoperative infection in the patients undergoing TACE.There were no significant differences in the levels of total bilirubin,aspartate aminotransferase,alanine aminotransferase,platelet and white blood cell between the two groups of patients;the levels of IL-8,CRP and PCT of the infection group were significantly higher than those of the non-infection group(P<0.05).The area under curve of the joint detection of IL-8,CRP and PCT was 0.946,remarkably higher than that of single index.CONCLUSIONThe incidence of postoperative infection in the liver cancer patients undergoing TACE is associated with multiple high risk factors,the IL-8,CRP and PCT have certain diagnostic value,which may facilitate the development of clinical interventions to the prevention of postoperative infection in the liver cancer patients undergoing TACE.
OBJECTIVE To explore the risk factors for postoperative infection in liver cancer patients undergoing transcatheter arterial chemoembolization(TACE)analyze the value of serum interleukin-8(IL-8),C-reactive protein(CRP)and procalcitonin(PCT)in diagnosis of infection.METHODS A total of 248 liver cancer patients who were treated in the hospital from Jan 2017 to Jun 2018 were recruited as the study objects,39 patients who had infection were assigned as the infection group,and 209 patients who did not have infection were set as the non-infection group.Univariate analysis and non-conditional multivariate logistic regression analysis were performed for risk factors for the postoperative infection in the patients undergoing TACE,and the value of serum IL-8,CRP and PCT in diagnosis of the infection was observed.RESULTS There were no significant differences in the gender,age,grade of liver function,size of tumor,number of times of TACE,portal vein thrombosis and portal hypertension between the infection group and the non-infection group.The multivariate logistic regression analysis showed that ascites,dosage of iodipin,history of liver abscess and rupture and hemorrhage of liver cancer were the independent risk factors for the postoperative infection in the patients undergoing TACE.There were no significant differences in the levels of total bilirubin,aspartate aminotransferase,alanine aminotransferase,platelet and white blood cell between the two groups of patients;the levels of IL-8,CRP and PCT of the infection group were significantly higher than those of the non-infection group(P<0.05).The area under curve of the joint detection of IL-8,CRP and PCT was 0.946,remarkably higher than that of single index.CONCLUSIONThe incidence of postoperative infection in the liver cancer patients undergoing TACE is associated with multiple high risk factors,the IL-8,CRP and PCT have certain diagnostic value,which may facilitate the development of clinical interventions to the prevention of postoperative infection in the liver cancer patients undergoing TACE.
引文
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[23]Fohlen A,Tasu JP,Kobeiter H,et al.Transarterial chemoembolization(TACE)in the management of hepatocellular carcinoma:results of a French national survey on current practices[J].Diagn Interv Imaging,2018,99(9):527-535.
[24]马明,马颖,孟塬,等.外周血炎症指标对肝动脉介入化疗栓塞术后感染的预测诊断价值分析[J].中华全科医学,2018,16(4):549-551.
[25]Shimizu T,Ishizuka M,Suzuki T,et al.The value of the C-reactive protein-to-albumin ratio is useful for predicting survival of patients with child-pugh class A undergoing liver resection for hepatocellular carcinoma[J].World J Surg,2018,42(7):2218-2226.
[2]Darnell A,Belmonte E,Reig M,et al.Evaluating the response to locoregional and systemic treatment for hepatocellular carcinoma[J].Radiologia,2018,60(5):424-436.
[3]Murata Y,Hiramatsu K,Yoshida Y,et al.Reactivation of intraabdominal tuberculous lymphadenopathy after drug-eluting beads transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma[J].Clin J Gastroenterol,2019,12(1):76-81.
[4]Ippolito D,Fior D,Bonaffini PA,et al.Quantitative evaluation of CT-perfusion map as indicator of tumor response to transarterial chemoembolization and radiofrequency ablation in HCC patients[J].Eur J Radiol,2014,83(9):1665-1671.
[5]Yoshimatsu R,Yamagami T,Ishikawa M,et al.Change in imaging findings on angiography-assisted CT during balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2016,39(6):865-874.
[6]胡兴龙,王胜智,吴敏良,等.原发性肝癌患者术后医院感染病原学特点及危险因素分析[J].中华医院感染学杂志,2017,27(20):4588-4591.
[7]Suner A,Carr BI,Akkiz H,et al.C-reactive protein and platelet-lymphocyte ratio as potential tumor markers in lowalpha-fetoprotein hepatocellular carcinoma[J].Oncology,2019,96(1):25-32.
[8]Shin JH,Yu E,Kim EN,et al.C-reactive protein overexpression in the background liver of hepatitis B virus-associated hepatocellular carcinoma is a prognostic biomarker[J].JPathol Transl Med,2018,52(5):267-274.
[9]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):705-720.
[10]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[11]刘晓琳,翟笑枫.肝癌术后综合治疗研究进展[J].中西医结合肝病杂志,2017,27(2):122-125.
[12]莫凯迪,杨建荣,李碧锦,等.原发性肝癌外科治疗方式选择及术后肿瘤复发防治相关性研究[J].实用癌症杂志,2017,32(1):124-127.
[13]Hatanaka T,Arai H,Kakizaki S.Balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma[J].World J Hepatol,2018,10(7):485-495.
[14]Endo K,Kuroda H,Oikawa T,et al.Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma[J].Scand J Gastroenterol,2018,53(12):1575-1583.
[15]Kodama K,Kawaoka T,Aikata H,et al.Comparison of clinical outcome of hepatic arterial infusion chemotherapy and sorafenib for advanced hepatocellular carcinoma according to macrovascular invasion and transcatheterarterial chemoembolization refractory status[J].J Gastroenterol Hepatol,2018,33(10):1780-1786.
[16]Ishimaru H,Morikawa M,Sakugawa T,et al.Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma:a case report and review of the literature[J].World J Gastroenterol,2018,24(37):4291-4296.
[17]依马木买买提江·阿布拉,徐林,易超,等.原发性肝癌患者手术后发生感染的危险因素研究[J].检验医学与临床,2015,12(24):3668-3670.
[18]齐亚刚.肝癌术后发生感染性并发症的危险因素分析[J].中国现代普通外科进展,2017,20(4):317-319.
[19]冯慧悦,祝胜美,吴祎洁,等.肝癌患者术后感染的危险因素分析[J].中华医院感染学杂志,2016,26(12):2750-2752.
[20]姜敏霞,陈旭高,姚红响.肝癌肝动脉化疗栓塞术后发生感染影响因素分析[J].介入放射学杂志,2018,27(2):133-136.
[21]Shirono T,Iwamoto H,Niizeki TS,et al.Epirubicin is more effective than miriplatin in balloon-occluded transcatheter arterial chemoembolization for hepatocellular carcinoma[J].Oncology,2019,96(2):79-86.
[22]Endo K,Kuroda H,Oikawa T,et al.Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma[J].Scand J Gastroenterol,2018,53(12):1575-1583.
[23]Fohlen A,Tasu JP,Kobeiter H,et al.Transarterial chemoembolization(TACE)in the management of hepatocellular carcinoma:results of a French national survey on current practices[J].Diagn Interv Imaging,2018,99(9):527-535.
[24]马明,马颖,孟塬,等.外周血炎症指标对肝动脉介入化疗栓塞术后感染的预测诊断价值分析[J].中华全科医学,2018,16(4):549-551.
[25]Shimizu T,Ishizuka M,Suzuki T,et al.The value of the C-reactive protein-to-albumin ratio is useful for predicting survival of patients with child-pugh class A undergoing liver resection for hepatocellular carcinoma[J].World J Surg,2018,42(7):2218-2226.