外周血感染性指标联合HMGB1 mRNA对胃癌根治术后感染并发症预测价值

Predictive value of peripheral blood infective indexes combined with HMGB1 mRNA in infectious complications after radical gastrectomy

目的探讨外周血感染性指标联合高迁移率族蛋白B1(HMGB1)mRNA对开腹与腹腔镜下胃癌根治术后感染并发症的预测价值。方法选取2018年1月-2020年7月张掖市甘州区人民医院183例行胃癌根治术患者为研究对象,术后检测外周血白细胞计数(WBC)、中性粒细胞/淋巴细胞比值(NLR)、中性粒细胞表面抗原CD64、超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、血清淀粉样蛋白A(SAA)以及HMGB1 mRNA。结果术后感染并发症36例,发生率为19.67%;严重感染并发症8例,发生率为4.37%。感染并发症患者中外周血WBC、NLR、CD64、hs-CRP、PCT、IL-8、TNF-α、SAA水平以及HMGB1 mRNA表达量均高于无感染并发症患者(P<0.05)。预测术后感染并发症的指标为CD64、hs-CRP、PCT、SAA、HMGB1 mRNA,五项联合预测的灵敏度为86.11%,特异度为80.27%。预测严重感染并发症的指标为PCT、SAA、HMGB1 mRNA,三项联合预测的灵敏度为87.50%,特异度为74.86%。结论外周血感染性指标CD64、hs-CRP、PCT、SAA、HMGB1 mRNA对胃癌根治术后感染并发症有较高的预测价值,尤其是PCT、SAA、HMGB1 mRNA可作为严重感染并发症早期筛查的标志物。

OBJECTIVE To investigate the predictive value of peripheral blood infective indexes combined with high mobility group box-1 protein(HMGB1)mRNA in infectious complications after open and laparoscopic radical gastrectomy.METHODS Total of 183 patients undergoing radical gastrectomy in Ganzhou District People′s Hospital of Zhangye City between Jan 2018 and Jul 2020 were recruited as the study objects.Peripheral blood white blood cell(WBC)count,neutrophil/lymphocyte ratio(NLR),neutrophil surface antigen CD64,high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),serum amyloid A(SAA)and HMGB1 mRNA were detected.RESULTS There were 36 cases with infectious complications after operation,with an incidence of 19.67%.Among them,there were 8 cases with severe infectious complications,with an incidence of 4.37%.Patients with infectious complications had significantly higher peripheral blood WBC,NLR,CD64,hs-CRP,PCT,IL-8,TNF-αand SAA levels,and HMGB1 mRNA expression level was significantly higher than those without infectious complications(P<0.05).The sensitivity and specificity of the combination of CD64,hs-CRP,PCT,SAA and HMGB1 mRNA used to predict postoperative infectious complications were 86.11%and 80.27%.PCT,SAA and HMGB1 mRNA were combined to predict postoperative severe infectious complications,with the sensitivity and specificity of 87.50%and 74.86%.CONCLUSION Peripheral blood infective indexes including CD64,hs-CRP,PCT,SAA and HMGB1 mRNA have high predictive value for infectious complications after radical gastrectomy,especially PCT,SAA and HMGB1 mRNA,which can be used for early screening of severe infectious complications.