感染对老年患者胃切除术后消化道重建的影响
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摘要
目的研究病原菌感染对行胃切除重建消化道术后老年患者的影响及病原菌感染的分布。方法选取2015年1月-2018年1月在医院行胃切除重建消化道术的老年患者235例,根据病原菌检查结果分为感染患者115例(感染组),无感染患者120例(对照组);选取同期体检的健康老年人118名为健康组。记录感染组病原菌类型及其分布,比较3组受试者血清肿瘤坏死因子α(TNF-α)、表皮生长因子(VEGF)表达水平,细胞外基质金属蛋白酶(MMP2、MMP3和MMP9)水平,胃蛋白酶原Ⅰ(PGI)、胃蛋白酶原Ⅱ(PGII)及胃泌素-17(Gastrin-17)蛋白水平。结果感染组分离病原菌115株,革兰阳性菌62株(53.9%),革兰阴性菌53株(46.1%);感染组TNF-α、VEGF、MMP2、MMP3、MMP9水平均高于对照组和健康组,差异有统计学意义(P<0.05);感染组PGⅠ、PGⅡ及胃泌素17蛋白水平均低于对照组和健康组,差异有统计学意义(P<0.05)。结论行胃切除重建消化道术的老年患者术后病原菌感染发生率高,感染以革兰阳性菌为主,同时感染导致基质金属蛋白酶表达及重构异常,并可能引起胃黏膜萎缩。
OBJECTIVE To observe the influence of pathogenic bacteria infection on elderly patients undergoing gastric resection and reconstruction of digestive tract and analyze the distribution of pathogens.METHODS A total of235 elderly patients who received gastric resection and reconstruction of digestive tract in the hospital from Jan2015 to Jan 2018 were enrolled in the study and divided into the infection group with 115 cases and the non-infection group with 120 cases(the control group)according to the result of etiological test.Meanwhile,118 healthy elderly people who received physical examination were chosen as the healthy group.The species of pathogens causing the infection were recorded,and the levels of serum tumor necrosis factorα(TNF-α),vascular epidermal growth factor(VEGF),extracellular matrix metalloproteinases(MMP2,MMP3 and MMP9),pepsinogen Ⅱ(PGII)and Gastrin-17 were observed and compared among the three groups of participants.RESULTS Totally 115 strains of pathogens were isolated from the infection group,62(53.9%)of which were gram-positive bacteria,and 53(46.1%)were gram-negative bacteria.The levels of TNF-α,VEGF,MMP2,MMP3 and MMP9 of the infection group were sighificantly higher than those of the control group and the healthy group.The levels of PG-Ⅰ,PG-Ⅱ and PG-17 protein of the infection group were lower than those of the control group and the healthy group(P<0.05).CONCLUSION The incidence of postoperative infection is high among the elderly patients who undergo the gastric resection and reconstruction of digestive tract,the gram-positive bacteria are dominant among the pathogens causing the infection,meanwhile the infection may lead to the abnormal expression and reconstruction of the matrix metalloproteinases as well as the atrophy of gastric mucosa.
OBJECTIVE To observe the influence of pathogenic bacteria infection on elderly patients undergoing gastric resection and reconstruction of digestive tract and analyze the distribution of pathogens.METHODS A total of235 elderly patients who received gastric resection and reconstruction of digestive tract in the hospital from Jan2015 to Jan 2018 were enrolled in the study and divided into the infection group with 115 cases and the non-infection group with 120 cases(the control group)according to the result of etiological test.Meanwhile,118 healthy elderly people who received physical examination were chosen as the healthy group.The species of pathogens causing the infection were recorded,and the levels of serum tumor necrosis factorα(TNF-α),vascular epidermal growth factor(VEGF),extracellular matrix metalloproteinases(MMP2,MMP3 and MMP9),pepsinogen Ⅱ(PGII)and Gastrin-17 were observed and compared among the three groups of participants.RESULTS Totally 115 strains of pathogens were isolated from the infection group,62(53.9%)of which were gram-positive bacteria,and 53(46.1%)were gram-negative bacteria.The levels of TNF-α,VEGF,MMP2,MMP3 and MMP9 of the infection group were sighificantly higher than those of the control group and the healthy group.The levels of PG-Ⅰ,PG-Ⅱ and PG-17 protein of the infection group were lower than those of the control group and the healthy group(P<0.05).CONCLUSION The incidence of postoperative infection is high among the elderly patients who undergo the gastric resection and reconstruction of digestive tract,the gram-positive bacteria are dominant among the pathogens causing the infection,meanwhile the infection may lead to the abnormal expression and reconstruction of the matrix metalloproteinases as well as the atrophy of gastric mucosa.
引文
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[15]赵建业,朱春平,李兆申.血清胃蛋白酶原、胃泌素-17、幽门螺杆菌抗体检测对萎缩性胃炎和胃癌的诊断价值[J].胃肠病学,2016,21(6):376-379.
[2]Roberts SE,Morrison-Rees S,Samuel DG,et al.Review article:the prevalence of Helicobacter pylori,and the incidence of gastric cancer across Europe[J].Aliment Pharmacol Ther,2015,43(3):334-345.
[3]邹文斌,李兆申.中国胃癌发病率及死亡率研究进展[J].中国实用内科杂志,2014,34(4):408-415.
[4]姜杰林,柏宇,杨文斌,等.近端胃癌切除术后消化道不同重建方式对患者预后影响分析[J].临床和实验医学杂志,2015,14(21):1806-1809.
[5]戚峰,刘彤,王鹏志.胃切除消化道重建方式与术后并发症[J].中国实用外科杂志,2013,33(4):337-339.
[6]Massarrat S,Haj-Sheykholeslami A.Increased serum pepsinogen II level as a marker of pangastritis and corpus-predominant gastritis in gastric cancer prevention[J].Arch Ira Med,2016,19(2):137-140.
[7]王丽娅.基质金属蛋白酶17的表达与胃癌临床特征间的关系[J].胃肠病学和肝病学杂志,2015,24(2):188-191.
[8]胡祥.2014年第4版日本《胃癌治疗指南》更新要旨[J].中国实用外科杂志,2015,35(1):16-19.
[9]胡祥.胃切除术后消化道重建方式的选择[J].中华消化外科杂志,2015,14(11):898-901.
[10]Bhuvarahamurthy V,Kristiansen GO,Johannsen M,et al.In situ gene expression and localization of metalloproteinases MMP1,MMP2,MMP3,MMP9,and their inhibitors TIMP1and TIMP2in human renal cell carcinoma[J].Oncol Rep,2006,15(5):1379.
[11]王冬,李勇,赵群,等.胃癌肿瘤组织及外周血中CypA、MMP-2、MMP-9、ICAM-1的变化及临床意义[J].临床与病理杂志,2015,35(1):43-44.
[12]Emeline T,Francois B,Jean-Yves P,et al.MMP2and MMP9serum levels are associated with favorable outcome in patients with inflammatory breast cancer treated with bevacizumabbased neoadjuvant chemotherapy in the beverly-2study[J].Oncotarget,2016,7(14):18531-18540.
[13]王宇强,贾永森,苏学涛,等.开放性骨折患者术后感染病原菌分布及对血清MMPs,SDF-1,VEGF和TNF-α表达影响研究[J].临床和实验医学杂志,2016,15(22):2223-2226.
[14]Loong TH,Soon NC,Nik Mahmud NRK,et al.Serum pepsinogen and gastrin-17as potential biomarkers for pre-malignant lesions in the gastric corpus[J].Biomed Rep,2017,7(5):460-468.
[15]赵建业,朱春平,李兆申.血清胃蛋白酶原、胃泌素-17、幽门螺杆菌抗体检测对萎缩性胃炎和胃癌的诊断价值[J].胃肠病学,2016,21(6):376-379.