摘要
目的探究结直肠肿瘤腹腔镜术后感染患者病原菌特征及对辅助性T细胞(T Helper,Th)1/Th2、单核细胞趋化因子1(monocyte chemoattractant protein-1,MCP-1)、可溶性髓样细胞触发受体1(soluble Trigge ring receptor expressed on myeloid cell-1,sTREM-1)表达的影响。方法选取结直肠肿瘤腹腔镜术后感染患者67例作为感染组,其中轻度感染23例,中度感染27例,重度感染17例;另选取结直肠肿瘤腹腔镜术后未出现感染患者67例作为非感染组。统计分析结直肠肿瘤腹腔镜术后感染病原菌特征,比较2组一般资料、术后Th1/Th2、MCP-1、sTREM-1水平,分析腹腔镜术后感染的影响因素,评价术后Th1/Th2、MCP-1、sTREM-1水平对腹腔镜术后感染的诊断价值,并分析术后Th1/Th2、MCP-1、sTREM-1水平与感染程度的相关性。结果感染组67例患者共培养出病原菌138株,其中革兰阴性菌67.39%,革兰阳性菌23.91%,其他8.70%。感染组体重指数≥24、Dukes分期C、D期、糖尿病、手术时间>2 h比例高于非感染组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,体重指数、Dukes分期、糖尿病、手术时间、术后3 d、7 d Th1/Th2、MCP-1、sTREM-1水平均为结直肠肿瘤腹腔镜术后感染影响因素(P<0.05)。绘制ROC曲线,可见术后3 d Th1/Th2、MCP-1、sTREM-1水平对腹腔镜术后感染的诊断AUC>术后7 d,术后3 d联合诊断AUC最大,为0.913,具有良好诊断效能。结直肠肿瘤腹腔镜术后感染患者术后3 d Th1/Th2与感染程度呈负相关,MCP-1、sTREM-1水平与感染程度呈正相关(P<0.05)。结论结直肠肿瘤腹腔镜术后感染患者术后3 d Th1/Th2明显下降,MCP-1、sTREM-1水平显著升高,可用于其诊断及感染程度评估,病原菌以大肠埃希菌、金黄色葡萄球菌为主,临床工作中需加以重视,采取针对性治疗方案,以便提高临床疗效,改善患者预后。
Objective To explore the characteristics of pathogenic bacteria in colorectal tumor patients with infection after laparoscopic surgery and their impact on the expression of T Helper(Th)1/Th2,monocyte chemoattractant protein-1(MCP-1)and soluble Trigge ring receptor expressed on myeloid cell-1(sTREM-1).Methods A total of 67 colorectal tumor patients with infection after laparoscopic surgery were selected as the infection group,including 23 with mild infection,27 with moderate infection,and 17 with severe infection.In addition,67 patients with colorectal tumors without infection during laparoscopic surgery were selected as the non-infection group.The characteristics of pathogenic bacteria in patients colorectal tumors after laparoscopic surgery were statistically analyzed,and the general data and the levels of Th1/Th2,MCP-1 and sTREM-1 after surgery were compared between two groups.The influencing factors of infection after laparoscopic surgery were analyzed,and the value of Th1/Th2,MCP-1 and sTREM-1 levels in the diagnosis of infection after laparoscopic surgery was evaluated.The correlation between the levels of Th1/Th2,MCP-1,sTREM-1 and the degree of infection was analyzed.Results The pathogenic bacteria culture results of 67 patients in the infection group showed that 138 pathogenic bacteria were cultured,including 67.39%of gram-negative bacteria,23.91%of gram-positive bacteria,and 8.70%of others.The proportion of patients with body mass index(BMI)≥24,Dukes stages C and D,diabetes,and duration of operation>2 h in the infection group was higher than that in the non-infection group,with significant difference(P<0.05).Logistic regression analysis showed that BMI,Dukes stages C and D,diabetes,duration of operation,and Th1/Th2,MCP-1,and sTREM-1 levels at 3 and 7 d after surgery were all influencing factors for infection after laparoscopic surgery in patients with colorectal tumors(P<0.05).The receiver operating characteristic(ROC)curve was drawn,which showed that the area under the ROC curve(AUC)of Th1/Th2,MCP-1,an
作者
丁海霞
DING Hai-xia(Department of Oncology, Central Hospital of Xi′an City, Shaanxi Province, Xi′an 710003, China)
出处
《河北医科大学学报》
CAS
2022年第3期295-301,共7页
Journal of Hebei Medical University
基金
陕西省医学科学研究课题计划(2017JM2878)。
关键词
结直肠肿瘤
腹腔镜检查
感染
colorectal neoplasms
laparoscopy
infections
