老年肺癌化疗患者合并肺部感染影响因素分析

Complicated pulmonary infection in patients with advanced lung cancer after chemotherapy

目的探讨老年肺癌化疗患者合并肺部感染相关因素、病原菌分布及免疫功能变化。方法选择203例晚期肺癌患者为研究对象,其中合并肺部感染26例(观察组),未发生肺部感染177例(对照组),检测并比较两组患者免疫功能指标变化;同时检测观察组患者痰培养病原菌分布,分析肺癌合并肺部感染的影响因素。结果观察组26例患者中,痰培养分离出病原菌37株,其中革兰阴性菌、革兰阳性菌、真菌分别占67.57%、29.73%和2.70%,差异有统计学意义(P<0.05)。与对照组患者比较,观察组患者外周血免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)水平均明显下降(均P<0.05),T淋巴细胞因子亚群CD4^+、CD4^+/CD8^+均明显降低而CD8^+明显升高(均P<0.05)。经非条件logistic回归分析,化疗时间>2周(HR=1.074,95%CI:1.102~8.397)、肺不张(HR=1.291,95%CI:1.124~8.310)、化疗后WBC≤3.0×10~9/L(HR=2.129,95%CI:1.501~5.306)、化疗后白蛋白≤30g/L(HR=0.908,95%CI:0.351~0.973)、化疗前体力状况评分60~80分(HR=1.210,95%CI:1.079~5.269)均是影响肺癌合并肺部感染的危险因素(均P<0.05)。结论肺癌患者合并肺部感染的病原菌以革兰阴性菌为主,会引起患者免疫功能下降,应有效控制其危险因素。

Objective To investigate the risk factors, distribution of pathogen, and immune function in advanced lung cancer patients complicated with pulmonary infection after chemotherapy. Methods Total 203 patients with advanced lung cancer were enrolled in the study, among whom 26 cases were complicated with pulmonary infection（infection group） and 177 cases were not complicate with pulmonary infection（control group）. The changes of immune function indexes in patients were determined and compared between two groups. The pathogenic bacteria in sputum culture in infection group were identified; the risk factors of complicated pulmonary infection in lung cancer patients were analyzed. Results Thirty seven bacterial strains were isolated, 67.57% were Gram-negative bacteria, 29.73% were Gram-positive bacteria and 2.70% were fungi（P〈0.05）. The levels of IgA, IgMand IgG in the infection group were significantly lower than those in the control group（P〈0.05）. Compared with the control group the CD4＋ level in infection group was decreased, CD8＋ increased and the CD4＋/CD8＋ decreased significantly（P〈0.05）. Non-conditional Logistic regression analysis showed that duration of chemotherapeutic 2 weeks（HR=1.074, 95%CI：1.102~8.397）, atelectasis（HR=1.291, 95%CI：1.124~8.310）, WBC count ≤3.0×10~9/L after chemotherapy（HR=2.129, 95%CI：1.501~5.306）, albumin ≤30 g/L after chemotherapy（HR=0.908, 95%CI：0.351~0.973）, physical condition score of 60~80 before chemotherapy（HR=1.210, 95%CI：1.079~5.269） were risk factors of complicated pulmonary infection in patients with advanced lung cancer. Conclusion Gram-negative bacteria are the main pathogens of pulmonary infection in lung cancer patients. The immune function in patients complicated with pulmonary infection is decreased. The risk factors of pulmonary infection are duration of chemotherapy 2 weeks, atelectasis, WBC count ≤3.0 ×10~9/L, albumin ≤30 g/L after chemotherapy, physical condition score 60~80 points before chemotherapy.