食管癌根治术后肺部感染患者肺功能和血清IL-6及IL-17、IL-1β水平变化及意义

Changes and significance of lung function,serum IL-6,IL-17 and IL-1β levels in patients with lung infection after radical resection of esophageal cancer

目的分析食管癌根治术后肺部感染患者肺功能、血清白细胞介素-6(IL-6)、IL-17、IL-1β水平变化及意义。方法回顾性分析2017年4月-2019年10月于周口市中心医院接受食管癌根治术的240例患者临床病历资料,记录患者术后肺部感染发生情况,根据是否发生肺部感染将研究对象分为感染组(n=32)与未感染组(n=208),采用Logistic回归分析食管癌根治术后肺部感染发生的危险因素。结果感染组年龄≥65岁、长期吸烟史、糖尿病、肺基础疾病史、手术时间≥4 h、术中出血量≥500 mL、呼吸机使用时间≥0.5 d、未预防性使用抗生素比例高于未感染组,差异均有统计学意义(P<0.05)。感染组手术前、后第1秒末用力呼气容积(FEV1)、用力呼吸肺活量(FVC)、FEV1/FVC、呼气流量峰值(PEF)均低于未感染组,肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、IL-1β、IL-6、IL-17均高于未感染组,差异均有统计学意义(P<0.05)。两组术后FEV1、FVC、FEV1/FVC、PEF均低于术前,TNF-α、CRP、IL-1β、IL-6、IL-17均高于术前,差异均有统计学意义(P<0.05)。Logistic回归分析显示,年龄≥65岁(OR=1.519,P=0.009)、既往肺基础疾病史(OR=1.557,P=0.016)、未预防性使用抗生素(OR=1.642,P=0.019)、术前PEF≤3469.51 mL/s(OR=1.730,P=0.011)、术前TNF-α≥10.36 ng/L(OR=1.687,P=0.008)、术前IL-6≥10.46 ng/L(OR=1.674,P=0.011)是食管癌根治术后肺部感染发生的独立危险因素,差异有统计学意义(P<0.05)。结论食管癌根治术后肺部感染患者肺功能下降,血清IL-6、IL-17、IL-1β水平上升,高龄、既往肺基础疾病史和术前TNF-α、IL-6高水平是食管癌根治术后肺部感染发生的危险因素。

Objective To analyze the changes and significance of lung function,serum interleukin-6(IL-6),IL-17 and IL-1βlevels in patients with lung infection after radical resection of esophageal cancer.Methods The clinical medical records of 240 patients who underwent radical resection of esophageal cancer in Zhoukou Central Hospital from April 2017to October 2019 were retrospectively analyzed.The occurrence of postoperative lung infection was recorded.According to presence or absence of lung infection,they were divided into infection group(n=32)and non-infection group(n=208).The risk factors of lung infection after radical resection of esophageal cancer were analyzed by logistic regression analysis.Results The proportions of cases with age≥65 years,histories of long-term smoking,diabetes mellitus and underlying lung diseases,operation time≥4 h,intraoperative blood loss≥500 mL,ventilator usage time≥0.5 d and non-prophylactic usage of antibiotics in infection group were higher than those in non-infection group(P<0.05).Before and after surgery,forced expiratory volume at the end of 1 second(FEV1),forced vital capacity(FVC),FEV1/FVC and peak expiratory flow(PEF)in infection group were lower than those in non-infection group(P<0.05),while tumor necrosis factor-α(TNF-α),Creactive protein(CRP),IL-1β,IL-6 and IL-17 levels were all higher than those in non-infection group(P<0.05).After surgery,FEV1,FVC,FEV1/FVC and PEF were decreased,while TNF-α,CRP,IL-1β,IL-6 and IL-17 were increased in both groups(P<0.05).Logistic regression analysis indicated that age not younger than 65 years old(OR=1.519,P=0.009),previous history of underlying lung disease(OR=1.557,P=0.016),non-prophylactic usage of antibiotics(OR=1.642,P=0.019),preoperative PEF not higher than 3469.51 mL/s(OR=1.730,P=0.011),preoperative TNF-αnot lower than 10.36 ng/L(OR=1.687,P=0.008)and preoperative IL-6 not lower than 10.46 ng/L(OR=1.674,P=0.011)were independent risk factors of lung infection after radical resection of esophageal cancer(P<0.05).Conclusions After radical resection of esophageal cancer,lung function was declined,while levels of serum IL-6,IL-17 and IL-1βwere increased in patients with lung infection.Old age,previous history of underlying lung diseases,and high preoperative levels of TNF-αand IL-6 were risk factors of lung infection after radical resection of esophageal cancer.