消化道肿瘤患者化疗后感染与病原学及外周血细胞因子研究

Infection status,etiology and peripheral blood cytokines in patients with gastrointestinal cancer after chemotherapy

目的调查消化道肿瘤患者化疗后的感染情况、病原菌分布特征以及患者感染后外周血细胞因子变化情况。方法选取2015年12月-2016年6月期间医院收治的消化道肿瘤患者226例,针对患者术后感染发生情况进行分析,采用单因素及多因素分析消化道肿瘤患者化疗后的感染危险因素,检测患者感染的致病菌,并对外周血细胞因子水平进行观察和比较。结果 226例患者化疗后发生感染23例,感染率10.18%;感染患者的感染部位主要集中在呼吸系统、消化道系统和泌尿系统;年龄、侵入操作、血清白蛋白、化疗周期、肿瘤分期、合并糖尿病和住院时间是消化道肿瘤患者感染的独立危险因素(P<0.05);感染患者共检出病原菌31株,其中革兰阴性菌20株占64.52%,革兰阳性菌9株占29.03%,真菌2株占6.45%;感染患者白细胞介素-6(IL-6)、IL-8、IL-12、IL-18及肿瘤坏死因子-α(TNF-α)分别为(99.02±38.33)ng/L、(96.12±40.42)ng/L、(134.35±43.12)ng/L、(253.89±50.11)ng/L和(24.03±7.28)ng/L,显著高于非感染患者(66.34±32.01)ng/L、(67.21±43.10)ng/L、(96.22±35.23)ng/L、(185.14±48.41)ng/L和(16.28±6.56)ng/L(P<0.05)。结论消化道肿瘤患者化疗后的感染情况应引起临床重视,革兰阴性菌是导致患者感染的主要致病菌,年龄、侵入操作、血清白蛋白、化疗周期、肿瘤分期、合并糖尿病和住院时间是患者感染的危险因素,患者感染后外周血细胞炎症因子水平会显著升高。

OBJECTIVE To investigate the changes of infection status,distribution characteristics of pathogens and peripheral blood cytokines in patients with gastrointestinal cancer after chemotherapy.METHODS A total of 226 patients with digestive tract cancer from Dec.2015 to Jun.2016 were chosen.The incidence of postoperative infection was analyzed.The risk factors of post-chemotherapy infection in patients with gastrointestinal cancer were analyzed by univariate analysis and multivariate regression analysis.The pathogens of infection in patients were detected,and the levels of peripheral blood cytokines were observed and compared.RESULTS Totally 23 cases were infected in the 226 patients,and the infection rate was 10.18%.The infection sites of infected patients were mainly in respiratory system,digestive tract system and urinary system.Age,invasive operation,serum albumin,chemotherapy cycle,tumor stage,diabetes mellitus and hospitalization time were the independent risk factors of gastrointestinal cancer infection（P〈0.05）.There were 31 strains of pathogens in 23 cases of infection,among which,20 strains were gram-negative bacteria,accounting for 64.52%,9 strains were gram-positive bacteria,accounting for 29.03%,and 2 strains were fungi,accounting for 6.45%.The interleukin-6（IL-6）,interleukin-8（IL-8）,interleukin-12（IL-12）,interleukin-18（IL-18）and tumor necrosis factor-α（TNF-α）in the infected group were（99.02±38.33）ng/L,（96.12±40.42）ng/L,（134.35±43.12）ng/L,（253.89±50.11）ng/L and（24.03±7.28）ng/L,which were significantly higher than non-infected patients of（66.34±32.01）ng/L,（67.21±43.10）ng/L,（96.22±35.23）ng/L,（185.14±48.41）ng/L and（16.28±6.56）ng/L,and the differences were significant（P〈0.05）.CONCLUSION The infection of gastrointestinal cancer patients after chemotherapy should be paid attention.Gram-negative bacteria are the main pathogens causing infections.Age,invasive operation,serum albumin,chemotherapy cycle,tumor stage,diabetes mellitus and hospitalization time are the risk factors of infections in patients,and the level of peripheral blood cell inflammatory factors after infections in patients will significantly increase.