结直肠癌患者术后感染的病原学特点及免疫功能的变化
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摘要
目的探讨结直肠癌患者术后感染的病原学特点,分析患者免疫功能指标及炎症因子水平变化。方法选取2015年1月-2017年12月在医院行手术治疗的结直肠癌患者为研究对象,87例术后感染患者为感染组。95例未发生感染患者为对照组。统计感染组患者感染部位和病原学特点;测定并比较两组患者免疫功能和炎症因子水平变化。结果 87例结直肠癌术后感染患者,其中手术部位感染率最高,47例占54.02%,其次为上呼吸道和下呼吸道感染。术后感染患者临床送检标本共检出病原菌90株,其中革兰阴性菌的比例为65.56%(59/90),革兰阳性菌的比例为25.56%(23/90)。感染组患者免疫功能指标CD8+T淋巴细胞、NK细胞水平均低于对照组,CD4+T淋巴细胞水平高于对照组(P<0.05)。感染组患者炎症因子白介素-10(IL-10)水平低于对照组,降钙素原(PCT)水平高于对照组(P<0.05)。结论结直肠癌术后感染可降低患者免疫功能,刺激炎症因子释放,术后感染以革兰阴性菌为主要致病菌。
OBJECTIVE To explore the etiological characteristics of postoperative infection in the patients with colorectal cancer and observe the changes of immune function indexes and inflammatory factors.METHODS The patients with colorectal cancer who received surgical procedures in the hospital from Jan 2015 to Dec 2017 were recruited as the study objects,87 patients who had postoperative infection were assigned as the infection group,and 95 patients who did not have infection were set as the control group.The infection sites and etiological characteristics were statistically analyzed,and the levels of immune function indexes and inflammatory factors were determined and compared between the two groups of patients.RESULTS Of the 87 colorectal cancer patients who had postoperative infection,47(54.02%)had surgical site infection,and the incidence of surgical site infection was the highest,followed by the incidence of upper respiratory tract infection and lower respiratory tract infection.Totally 90 strains of pathogens were isolated from the submitted clinical specimens of the patients with postoperative infection,65.56%(59/90)of which were gram-negative bacteria,and 25.56%(23/90)were gram-positive bacteria.The levels of immune function indexes CD_8~+ T lymphocyte and NK cells of the infection group were significantly lower than those of the control group,while the CD_4~+ T lymphocyte level of the infection group was significantly higher than that of the control group(P<0.05).The inflammatory factor interleukin-10(IL-10)level of the infection group was significantly lower than that of the control group,while the procalcitonin(PCT)level of the infection group was significantly higher than that of the control group(P<0.05).CONCLUSION The postoperative infection may reduce the immune function of the colorectal cancer patients and stimulate the release of inflammatory cytokines.The gram-negative bacteria are dominant among the pathogens causing the postoperative infection.
OBJECTIVE To explore the etiological characteristics of postoperative infection in the patients with colorectal cancer and observe the changes of immune function indexes and inflammatory factors.METHODS The patients with colorectal cancer who received surgical procedures in the hospital from Jan 2015 to Dec 2017 were recruited as the study objects,87 patients who had postoperative infection were assigned as the infection group,and 95 patients who did not have infection were set as the control group.The infection sites and etiological characteristics were statistically analyzed,and the levels of immune function indexes and inflammatory factors were determined and compared between the two groups of patients.RESULTS Of the 87 colorectal cancer patients who had postoperative infection,47(54.02%)had surgical site infection,and the incidence of surgical site infection was the highest,followed by the incidence of upper respiratory tract infection and lower respiratory tract infection.Totally 90 strains of pathogens were isolated from the submitted clinical specimens of the patients with postoperative infection,65.56%(59/90)of which were gram-negative bacteria,and 25.56%(23/90)were gram-positive bacteria.The levels of immune function indexes CD_8~+ T lymphocyte and NK cells of the infection group were significantly lower than those of the control group,while the CD_4~+ T lymphocyte level of the infection group was significantly higher than that of the control group(P<0.05).The inflammatory factor interleukin-10(IL-10)level of the infection group was significantly lower than that of the control group,while the procalcitonin(PCT)level of the infection group was significantly higher than that of the control group(P<0.05).CONCLUSION The postoperative infection may reduce the immune function of the colorectal cancer patients and stimulate the release of inflammatory cytokines.The gram-negative bacteria are dominant among the pathogens causing the postoperative infection.
引文
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[25]Levi F,Pasche C,Lucchini F,et al.Macronutrients and colorectal cancer:a Swiss case-control study[J].Ann Oncol,2002,13(3):369-373.
[2]Ishizuka M,Nagata H,Takagi K,et al.Clinical significance of the C-reactive protein to albumin ratio for survival after surgery for colorectal cancer[J].Ann Surg Oncol,2016,23(3):900-907.
[3]Gustafsson UO,Oppelstrup H,Thorell A,et al.Adherence to the ERAS protocol is associated with 5-year survival after colorectal cancer surgery:a retrospective cohort study[J].World J Surg,2016,40(7):1741-1747.
[4]张德重,王丽丽,陈炳合,等.结直肠癌患者术后感染的危险因素及病原菌分布情况分析[J].中华医院感染学杂志,2017,27(5):1105-1108.
[5]张凯歌,郭晓玲,蔡圣鑫,等.地西他滨对骨髓增生异常综合征患者PD-1/PD-L1表达的影响[J].临床肿瘤学杂志,2018,23(1):30-34.
[6]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.
[7]Champiat S,Dercle L,Ammari S,et al.Hyperprogressive disease is a new pattern of progression in cancer patients treated by antiPD-1/PD-L1[J].Clin Cancer Res,2017,23(8):1920-1928.
[8]Hirano Y,Hattori M,Douden K,et al.Single-incision laparoscopic surgery for colorectal cancer[J].World J Gastrointest Surg,2016,8(1):95-100.
[9]Ramirez MF,Ai D,Bauer M,et al.Innate immune function after breast,lung,and colorectal cancer surgery[J].J Surg Res,2015,194(1):185-193.
[10]王成,张成武,袁丽萍,等.结直肠癌患者手术部位感染的病原学特征分析[J].中华医院感染学杂志,2016,26(8):1807-1809.
[11]Renda A,Iovino F,Capasso L,et al.Radioimmunoguided surgery in colorectal cancer:a 6-year experience with four different technical solutions[J].Semin Surg Oncol,2015,15(4):226-230.
[12]Regenbogen SE,Veenstra CM,Hawley ST,et al.The personal financial burden of complications after colorectal cancer surgery[J].Cancer,2015,120(19):3074-3081.
[13]李东正,周建农.肠道微生态制剂对结直肠癌患者术后免疫功能及并发症的影响[J].中国医药导报,2016,13(35):106-109.
[14]Tajima T,Mukai M,Yamazaki M,et al.Comparison of hand-assisted laparoscopic surgery and conventional laparotomy for colorectal cancer:Interim results from a single institution[J].Oncol Lett,2014,8(2):627-632.
[15]赵铮铮,吴露霞,虞哲科,等.根治性结肠癌切除术后腹腔感染对临床预后的影响[J].中华医院感染学杂志,2017,27(9):2047-2049.
[16]缪希莉,梅四清,高贵民.无症状期HIV感染者外周血T细胞亚群含量、PD-1/PD-L1表达量与病毒载量的关系[J].海南医学院学报,2016,22(15):1656-1659.
[17]张爱军,严姣华,陶京,等.CD4+CD25+Foxp3+调节性T细胞对结直肠癌肿瘤免疫的影响及与临床病理的关系[J].中国现代普通外科进展,2016,19(7):505-510.
[18]刘倩,史健.免疫检测点与结直肠癌免疫治疗的研究进展[J].广东医学,2016,37(13):2053-2055.
[19]冯明明.血清PCT对结直肠癌术后感染性并发症的诊断价值[J].中国现代医学杂志,2017,27(7):112-116.
[20]Kobayashi S,Ito M,Yamamoto S,et al.Randomized clinical trial of skin closure by subcuticular suture or skin stapling after elective colorectal cancer surgery[J].Br J Surg,2015,102(5):495-500.
[21]Long AG,Lundsmith ET,Hamilton KE.Inflammation and colorectal cancer[J].Curr Colorectal Cancer Rep,2017,13(4):341-351.
[22]Xu K,Jiang B.Analysis of mucosa-associated microbiota in colorectal cancerp[J].Med Sci Monit,2017,23:4422-4430.
[23]Flemer B,Lynch DB,Brown JMR,et al.Tumour-associated and non-tumour-associated microbiota in colorectal cancer[J].Gut,2017,66(4):633-643.
[24]Dienstmann R,Vermeulen L,Guinney J,et al.Consensus molecular subtypes and the evolution of precision medicine in colorectal cancer[J].Nature Reviews Cancer,2017,17(2):79-85.
[25]Levi F,Pasche C,Lucchini F,et al.Macronutrients and colorectal cancer:a Swiss case-control study[J].Ann Oncol,2002,13(3):369-373.