晚期肺癌患者化疗后肺部感染的病原菌分布和对免疫功能的影响研究

Distribution of pathogens causing pulmonary infections in patients with advanced lung cancer after chemotherapy and influence on immune function

目的分析晚期肺癌化疗后肺部感染的病原菌分布及对免疫功能的影响研究。方法分析2015年1月-2017年1月医院接受化疗的118例晚期肺癌患者的临床资料,依据化疗后是否并发肺部感染分为感染组58例及对照组60例,采用美国赛默飞微生物全自动鉴定仪进行病原菌鉴定分型,对比两组患者T细胞亚群及外周血免疫球蛋白等免疫功能指标。结果感染组58例患者共分离病原菌80株,其中革兰阴性菌55株占68.75%,革兰阳性菌21株占26.25%,真菌4株占5.00%;感染组患者CD3+T细胞、CD_4^+T细胞、CD_8^+T淋巴细胞及CD_4^+/CD_8^+均显著低于对照组(P<0.05);感染组患者外周血IgA、IgG及IgM水平均显著低于对照组,以上差异均有统计学意义(P<0.05)。结论晚期肺癌患者化疗后肺部感染主要以革兰阴性菌为主,感染可加剧患者免疫功能异常。

OBJECTIVE To investigate the distribution of pathogens causing pulmonary infections in patients with advanced lung cancer after chemotherapy and observe the influence on immune function.METHODS The clinical data of 118 advanced lung cancer patients who received chemotherapy in the hospital from Jan 2015 to Jan 2017 were analyzed,the enrolled patients were divided into the infection group with 58 cases and the control group with 60 cases according to the status of occurrence of pulmonary infection after the chemotherapy.The isolated patho-gens were identified by using automatic microbilogical identification system of Thermo Fisher in the USA,and the immune function indexes such as the T lymphocytes subsets and peripheral blood immunoglobulins were observed and compared between the two groups of patients.RESULTS A total of 80 strains of pathogens were isolated from the 58 patients in the infection group,of which 55（68.75%）were gram-negative bacteria,21（26.25%）were gram-positive bacteria,and 4（5.00%）were fungi.The levels of CD3＋ T cell,CD4＋ T cell,CD8＋ T lymphocyte and CD4＋ /CD8＋ of the infection group were significantly lower than those of the control group（P〈0.05）.The levels of peripheral blood IgA,IgG and IgM of the infection group were significantly lower than those of the con-trol group（P〈0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the pulmonary infection in the advanced lung cancer patients after chemotherapy,and the infection may exacerbate the immune dysfunction.