肺癌患者肺部感染的病原菌分布及血清中NSE和CYFRA21-1病理表达的临床研究

Clinical analysis on pathogenic bacteria distribution and serum NSE and CY-FRA21-1 pathological expressions in patients with pulmonary cancer accompanying pulmonary infection

目的探讨肺癌患者肺部感染的病原菌分布及耐药性特点,同时观察血清神经元特异性烯醇化酶(NSE)、血清细胞甲蛋白19片段(CYFRA21-1)、癌胚抗原(CEA)病理表达对肺癌的诊断及鉴别诊断的临床意义。方法选取于2011年3月-2017年3月医院收治的肺癌伴肺部感染患者102例为A组,将同期住院无肺癌伴肺部感染患者102例为B组。取患者痰液至无菌试管中并送检进行细菌培养,观察分析病原菌特点及血清中NSE、CYFRA21-1病理表达水平。结果 102例肺癌肺部感染患者共分离出153株病原菌,其中革兰阴性菌91株占59.48%、革兰阳性菌45株占29.41%、真菌17株占11.11%;A组的NSE、CYFRA21-1、CEA的阳性率均高于B组(P<0.05);NSE病理表达水平在小细胞型肺癌最高,与其他类型肺癌的表达水平比较差异有统计学意义,CYFRA21-1病理表达水平在肺腺癌最高,与其他类型肺癌的表达水平比较差异有统计学意义(P<0.05)。结论对肺癌合并肺部感染患者需早期行细菌培养及药敏试验检查,根据相关检查结果选择对症抗菌药物治疗,对肺癌合并肺部感染患者进行早期有效治疗,降低并发症所致病死率,CYFRA21-1、及NSE的病理表达水平增高不仅对肺癌的早期诊断具有重要作用,还可对不同类型的肺癌进行初步判定。

OBJECTIVE To analyze distribution and resistance of pathogenic bacteria in patients with pulmonary cancer accompanying pulmonary infection and meanwhile observe the clinical significance of serum NSE,CYFRA21-1 and CEA pathological expressions for diagnosis and differential diagnosis of pulmonary cancer.METHODS A total of 102 patients with pulmonary cancer accompanying pulmonary infection were collected in our hospital during Mar.2011 to Mar.2017 and were defined as group A by the investigators,while the inpatients without pulmonary cancer were defined as group B during the corresponding period.Sputamentum was collected into a sterile test tube and delivered to laboratory for bacterial culture.The characteristics of pathogenic bacteria and the serum NSE and CY-FRA21-1 pathological expressions were observed and analyzed.RESULTS Totally153 strains of pathogens were isolated from 102 patients with pulmonary cancer accompanying pulmonary infection,including 91 strains of gram-negative bacteria accounting for 59.48%,45 strains of gram-positive bacteria accounting for 29.41%,and 17 strains of fungi accounting for 11.11%.The posi-tive rates of NSE,CYFRA 21-1 and CEA in group A were significantly higher than those in group B（P〈0.05）.The pathological expression level of NSE was the highest in small cell lung cancer,and there was a significant difference in the expression level with other types of lung cancer.The pathological expression level of CYFRA21-1 was the highest in lung adenocarcinoma,and there was a significant difference in the expression level with other types of lung cancer（P〈0.05）.CONCLUSIONIn the patients with pulmonary cancer accompanying pulmonary infection,it is necessary to conduct bacteria culture and drug sensitive test as soon as possible before initiating infection therapy in order to provide the reference for suitable antibacterial drug therapy according to relative detection.Initial effective therapy for the patients with pulmonary cancer accompanying pulmonary infection can reduce mortality induced by the complications.The pathological expression levels of CYFRA21-1 and NSE are not only important for the early diagnosis of pulmonary cancer,but also the preliminary determination of different types of pulmonary cancer.