胸腺肽α1对原发性肝癌肝动脉化疗栓塞治疗患者感染的防控效果研究

Effect of thymosin α1 on prevention and control of infections in primary liver cancer patients treated with transcatheter arterial chemoembolization

目的探讨胸腺肽α1对肝癌化疗患者感染的影响。方法选取医院2011年8月-2016年11月收治的194例肝癌门静脉癌栓患者为研究对象,将患者分为试验组和对照组,每组97例,两组均接受肝动脉化疗栓塞(TACE)治疗,试验组联合应用胸腺肽α1治疗,统计两组患者医院感染率,进行病原菌鉴定,化疗前、化疗结束时检测自然杀伤(NK)和T细胞亚群(CD3^+、CD4^+、CD8^+)。结果试验组共6例发生感染,感染率为6.19%;对照组共16例发生感染,感染率为16.49%,试验组感染率低于对照组(P<0.05);感染部位均以呼吸道和手术部位为主;试验组共检出9株病原菌,其中革兰阴性菌6株,占66.67%,革兰阳性菌3株,占33.33%;对照组共检出22株病原菌,其中革兰阴性菌12株,占54.55,革兰阳性菌8株,占36.36%,真菌2株,占9.09%;化疗前两组CD3^+、CD4^+、CD8^+和NK细胞比例比较差异均无统计学意义;化疗结束时,试验组CD3^+、CD4^+和NK细胞比例上升(P<0.05),CD8^+比例降低(P<0.05),而对照组CD3^+、CD4^+和NK细胞比例降低(P<0.05),CD8^+比例上升(P<0.05);两组CD3^+、CD4^+、CD8^+和NK细胞比例比较差异有统计学意义(P<0.05)。结论胸腺肽α1有助于提高肝癌门静脉癌栓患者化疗期间CD4^+细胞介导的免疫反应,医院感染率的降低可能与此相关。

OBJECTIVE To explore the influence of thymosinα1 on infections in liver cancer patients receiving chemotherapy.METHODS A total of 194 liver cancer patients with portal vein tumor thrombus who were treated in the hospital from Aug 2011 to Nov 2016 were recruited as the study objects and divided into the experimental group and the control group,with 97 cases in each group.Both groups were treated with transcatheter arterial chemoembolization（TACE）,the experimental group was treated with combined use of thymosinα1.The incidence rates of nosocomial infections were statistically analyzed,the pathogens were identified,and the natural killer（NK）cells and T cell subsets（CD3~＋,CD4~＋,CD8~＋）were detected before and after the chemotherapy.RESULTS Totally 6 patients had infection in the experimental group,with the infection 6.19%;totally 16 patients had infections in the control group with the infection rate 16.49%;the infection rate of the experimental group was significantly lower than that of the control group（P〈0.05）.The respiratory tract and surgical sites were the major infection sites.Totally 9 strains of pathogens were isolated in the experimental group,including 6（66.67%）strains of gram-negative bacteria and 3（33.33%）strains of gram-positive bacteria;totally 22 strains of pathogens were isolated in the control group,including 12（54.55%）strains of gram-negative bacteria,8（36.36%）strains of gram-positive bacteria and 2（9.09%）stains of fungi.There was no significant difference in the percentage of CD3~＋,CD4~＋,CD8~＋or NK cells between the two groups before the chemotherapy;the percentages of CD3~＋,CD4~＋and NK cells of the experimental group were increased after the chemotherapy（P〈0.05）,the percentage of CD8~＋was significantly reduced（P〈0.05）,however,the percentages of CD3~＋,CD4~＋and NK cells of the control group were significantly reduced（P〈0.05）,while the percentage of CD8~＋was significantly increased（P〈0.05）;there were significant differences in the percentages of CD3~＋,CD4~＋,CD8~＋and NK cells between the two groups（P〈0.05）.CONCLUSION The thymosinα1 may help to improve the CD4~＋cell-mediated immune response of the liver cancer patients with portal vein tumor thrombus,which may be related to the reduction of incidence of nosocomial infections.