宫颈癌术后同步放化疗患者医院感染炎性因子与T淋巴细胞亚群研究

Changes of inflammatory factors and T lymphocyte subsets in patients with cervical cancer after concurrent radiotherapy and chemotherapy

目的探讨宫颈癌术后同步放化疗患者医院感染炎症因子和T淋巴细胞亚群变化。方法选择2015年4月-2017年5月于宁波市鄞州人民医院进行宫颈癌术后化疗患者330例为研究对象,探讨术后同步放化疗患者医院感染发生情况,感染和未感染患者炎性因子和T淋巴细胞变化;并分析感染患者病原菌情况。结果宫颈癌术后同步放化疗患者医院感染122例,感染率为36.97%;以泌尿系统感染为主占55.74%(68/122)。两组治疗后血清CRP和PCT水平较治疗前降低(P<0.05),且感染患者治疗后C-反应蛋白(CRP)和降钙素原(PCT)分别为(16.46±2.87)mg/L和(1.03±0.25)ng/ml高于未感染患者。两组治疗后CD3^+、CD4^+和CD4^+/CD8^+较治疗前降低(P<0.05),且感染患者CD3^+、CD4^+和CD4^+/CD8^+分别为(45.16±2.18)、(24.52±2.16)和(0.81±0.12)低于未感染患者(P<0.05)。122例感染患者共培养分离病原菌144株其中革兰阴性菌86株占59.72%,以大肠埃希菌和铜绿假单胞菌为主;革兰阳性菌54株占37.50%,以金黄色葡萄球菌和粪肠球菌为主;真菌4株占2.78%。结论宫颈癌术后同步放化疗患者医院感染存在炎症反应且患者免疫功能下降,医院感染患者检出病原菌以革兰阴性菌为主,应严格按照药敏结果合理应用抗菌药物。

OBJECTIVE To investigate the changes of inflammatory factors and T lymphocyte subsets in patients with cervical cancer after concurrent radiotherapy and chemotherapy.METHODS The 330 patients with cervical cancer after operation in May 2015 to Apr.2017 were selected as the research subjects.The incidence of nosocomial infection in patients with postoperative concurrent chemoradiotherapy and the changes of inflammatory factors and T lymphocytes in infected and uninfected patients were investigated.The pathogens in the infected patients were also analyzed.RESULTS There were 122 patients with nosocomial infection after concurrent chemoradiotherapy for cervical cancer,and the infection rate was 36.97%.Urinary system infection accounted for 55.74%(68/122).After treatment,the levels of C-reactive protein(CRP)and procalcitonin(PCT)in serum of the two groups were significantly lower than those before treatment(P<0.05),and the levels of CRP and PCT in the infected patients were respectively(16.46±2.87)mg/L and(1.03±0.25)ng/ml after the treatment,higher than those in the uninfected patients.After treatment,CD3^+,CD4^+,and CD4^+/CD8^+in the two groups were significantly lower than those before treatment(P<0.05),and the levels of CD3^+,CD4^+,and CD4^+/CD8^+in the infected patients were(45.16±2.18),(24.52±2.16)and(0.81±0.12),significantly lower than those in the uninfected patients(P<0.05).A total of 144 strains of pathogens were isolated and cultured from the 122 infected patients,of which 86 strains were Gram-negative bacteria accounting for 59.72%,mainly Escherichia coli and Pseudomonas aeruginosa,54 strains were Gram-positive bacteria accounting for 37.50%,mainly Staphylococcus aureus and Enterococcus faecalis,and 4 strains were fungi accounting for 2.78%.CONCLUSION There is inflammatory reaction in the nosocomial infection and the immune function of the patients is decreased during the postoperative radiotherapy and chemotherapy of cervical cancer.The main pathogens for nosocomial infection are Gram-negative bacteria,and the antibiotics should be applied in strict accordance with the results of drug sensitivity.