动态监测胃癌术后感染患者T淋巴细胞亚群水平的临床价值
|
摘要
目的分析胃癌根治术术后感染的影响因素,并探讨T淋巴细胞亚群的变化与术后感染的关系。方法 2014年6月-2017年11月在医院接受胃癌根治术的患者80例,根据术后是否合并感染,将80例患者分为观察组(术后合并感染)和对照组(术后未合并感染)。分析术后感染的发病率和影响因素。采用流式细胞技术分别检测两组术前、术后1d、4d和9d的T淋巴细胞亚群水平的变化。结果 80例患者中,有15例术后并发感染,感染率为18.75%。Logistic回归分析发现,手术范围和肿瘤分期是术后感染的独立影响因素(P<0.05)。术后4d时,观察组CD_3、CD_4、CD_4/CD_8明显低于对照组,而CD_8高于对照组差异有统计学意义(P<0.05),其余时间段无明显差异。结论手术范围和肿瘤分期是术后感染的独立影响因素。术后4d,CD_3、CD_4和CD_4/CD_8表达下降,而术后大多数并发症也是在术后4～5d,这说明T细胞亚群的变化与术后感染有密切关系。因此手术前后检测T细胞亚群的变化对早期发现和治疗感染性并发症有重要意义。
OBJECTIVE To investigate the influencing factors for postoperative infections in the patients with gastric cancer and explore the correlation between the change of T lymphocyte subsets and the postoperative infections.METHODS A total of 80gastric cancer patients who received gastrectomy from Jun 2014to Nov 2017were enrolled in the study.According to the status of postoperative infections,the patients who were complicated with postoperative infections were assigned as the observation group,and the patients who were not complicated with postoperative infections were set as the control group.The incidence of postoperative infections and influencing factors were analyzed,and the levels of T lymphocyte subsets of the two groups of patients were detected by means of flow cytometry before the surgery and after the surgery for 1,4and 9days.RESULTS Of the 80patients,15were complicated with the postoperative infections,with the infection rate 18.75%.Logistic regression analysis showed that scope of surgery and tumor stage were the independent influencing factors for the postoperative infection(P<0.05).The levels of CD_3,CD_4and CD_4/CD_8of the observation group were significantly lower than those of the control group after the surgery for 4days,however,the CD_8level of the observation group was significantly higher than that of the control group(P<0.05);there were no significant differences in the above indexes at other time points.CONCLUSIONThe scope of surgery and tumor stage are the independent influencing factors for the postoperative infections.The levels of CD_3,CD_4and CD_4/CD_8are reduced after the surgery for 4days,most of the complications occur after the surgery for 4～5days,showing that the change of T lymphocyte subsets is closely associated with the postoperative infections.It is of great significance to detect the levels of T lymphocyte subsets before and after the surgery so as to facilitate the early diagnosis and treatment of the infectious complications.
OBJECTIVE To investigate the influencing factors for postoperative infections in the patients with gastric cancer and explore the correlation between the change of T lymphocyte subsets and the postoperative infections.METHODS A total of 80gastric cancer patients who received gastrectomy from Jun 2014to Nov 2017were enrolled in the study.According to the status of postoperative infections,the patients who were complicated with postoperative infections were assigned as the observation group,and the patients who were not complicated with postoperative infections were set as the control group.The incidence of postoperative infections and influencing factors were analyzed,and the levels of T lymphocyte subsets of the two groups of patients were detected by means of flow cytometry before the surgery and after the surgery for 1,4and 9days.RESULTS Of the 80patients,15were complicated with the postoperative infections,with the infection rate 18.75%.Logistic regression analysis showed that scope of surgery and tumor stage were the independent influencing factors for the postoperative infection(P<0.05).The levels of CD_3,CD_4and CD_4/CD_8of the observation group were significantly lower than those of the control group after the surgery for 4days,however,the CD_8level of the observation group was significantly higher than that of the control group(P<0.05);there were no significant differences in the above indexes at other time points.CONCLUSIONThe scope of surgery and tumor stage are the independent influencing factors for the postoperative infections.The levels of CD_3,CD_4and CD_4/CD_8are reduced after the surgery for 4days,most of the complications occur after the surgery for 4～5days,showing that the change of T lymphocyte subsets is closely associated with the postoperative infections.It is of great significance to detect the levels of T lymphocyte subsets before and after the surgery so as to facilitate the early diagnosis and treatment of the infectious complications.
引文
[1]Xiao H,Xiao Y,Quan H,et al.Intra-abdominal infection after radical gastrectomy for gastric cancer:Incidence,pathogens,risk factors and outcomes[J].Int J Surg,2017,48:195-200.
[2]Chen DS,Mellman I.Elements of cancer immunity and the cancer-immune set point[J].Nature,2017,541(7637):321-330.
[3]宗祥龙,季鑫,贾子豫,等.胃癌患者手术前后细胞免疫水平变化与术后感染关系的研究[J].中华医院感染学杂志,2017,27(6):1297-1300.
[4]Sano T,Coit DG,Kim HH,et al.Proposal of a new stage grouping of gastric cancer for TNM classification:International Gastric Cancer Association staging project[J].Gastric Cancer,2017,20(2):217-225.
[5]Friendlander AH,Ettinger RL.Karnofsky performance status scale[J].Spec Care Dentist,2009,29(4):147-148.
[6]Mao F,Hui K,Zhao Y,et al.Increased tumor-infiltrating CD45RA-CCR7-regulatory T-cell subset with immunosuppressive properties foster gastric cancer progress[J].Cell Death Dis,2017,8(8):e3002.
[7]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.
[8]Climent M,Munarriz M,Blazeby JM,et al.Weight loss and quality of life in patients surviving 2years after gastric cancer resection[J].Eur J Surg Oncol,2017,43(7):1337-1343.
[9]许洪宝,蔡炜龙,汪伟民,等.老年胃癌患者手术部位感染相关并发症的危险因素分析[J].中华普通外科杂志,2018,33(4):276-279.
[10]刘保荣,慕喜喜,袁博,等.益生菌对胃癌术后感染并发症以及术后恢复的影响[J].实用癌症杂志,2018,33(1):109-112.
[11]非糖尿病胃癌患者手术应激性高血糖对术后感染及预后的影响分析[J].中华医院感染学杂志,2017,27(12):2740-2743.
[12]Zarour HM.Reversing T-cell dysfunction and exhaustion in cancer[J].Clin Cancer Res,2016,22(8):1856-1864.
[13]Takaya S,Saito H,Ikeguchi M.Upregulation of immune checkpoint molecules,pD-1and LAG-3,on CD4+and CD8+T cells after gastric cancer surgery[J].Yonago Acta Med,2015,58(1):39-44.
[2]Chen DS,Mellman I.Elements of cancer immunity and the cancer-immune set point[J].Nature,2017,541(7637):321-330.
[3]宗祥龙,季鑫,贾子豫,等.胃癌患者手术前后细胞免疫水平变化与术后感染关系的研究[J].中华医院感染学杂志,2017,27(6):1297-1300.
[4]Sano T,Coit DG,Kim HH,et al.Proposal of a new stage grouping of gastric cancer for TNM classification:International Gastric Cancer Association staging project[J].Gastric Cancer,2017,20(2):217-225.
[5]Friendlander AH,Ettinger RL.Karnofsky performance status scale[J].Spec Care Dentist,2009,29(4):147-148.
[6]Mao F,Hui K,Zhao Y,et al.Increased tumor-infiltrating CD45RA-CCR7-regulatory T-cell subset with immunosuppressive properties foster gastric cancer progress[J].Cell Death Dis,2017,8(8):e3002.
[7]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.
[8]Climent M,Munarriz M,Blazeby JM,et al.Weight loss and quality of life in patients surviving 2years after gastric cancer resection[J].Eur J Surg Oncol,2017,43(7):1337-1343.
[9]许洪宝,蔡炜龙,汪伟民,等.老年胃癌患者手术部位感染相关并发症的危险因素分析[J].中华普通外科杂志,2018,33(4):276-279.
[10]刘保荣,慕喜喜,袁博,等.益生菌对胃癌术后感染并发症以及术后恢复的影响[J].实用癌症杂志,2018,33(1):109-112.
[11]非糖尿病胃癌患者手术应激性高血糖对术后感染及预后的影响分析[J].中华医院感染学杂志,2017,27(12):2740-2743.
[12]Zarour HM.Reversing T-cell dysfunction and exhaustion in cancer[J].Clin Cancer Res,2016,22(8):1856-1864.
[13]Takaya S,Saito H,Ikeguchi M.Upregulation of immune checkpoint molecules,pD-1and LAG-3,on CD4+and CD8+T cells after gastric cancer surgery[J].Yonago Acta Med,2015,58(1):39-44.