原发性肺癌放疗后肺部感染患者呼吸指标及血清炎性因子的变化分析

Variation analysis of respiratory indexes and serum inflammatory factors in patients of primary lung cancer with pulmonary infection after radiotherapy

目的探讨原发性肺癌放疗后肺部感染患者呼吸指标及血清炎性因子的改变情况。方法选择自2015年8月-2018年9月在内蒙古医科大学附属医院呼吸与危重症医学科接受放疗治疗的原发性肺癌患者120例,根据患者是否发生放疗后肺部感染将120例患者分为两组,感染组即原发性肺癌放疗后发生肺部感染组52例,根据发生感染的程度不同,肺部感染患者中轻度感染患者14例,中度肺部感染患者25例,重度肺部感染患者13例;未感染组即原发性肺癌放疗后未发生肺部感染组68例;对比两组患者和感染组不同感染程度患者的血清炎性因子表达水平,包括降钙素原(procalcitonin,PCT)、超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的表达水平;同时对比两组患者和感染组不同感染程度患者的相关呼吸指标,包括肺的动态顺应性(dynamic compliance,Cdyn)、气道阻力(air way resistance,RAW)、气道平均压(mean pressure,Pmean)和响应频率(response frequency,Fres)。结果放疗后,感染组患者Cdyn水平较未感染组患者低(P<0.001),感染组患者RAW、Pmean和Fres水平较未感染组患者高(P<0.001),感染组的Cdyn水平随感染情况加重而降低,RAW、Pmean及Fres水平随感染情况加重而提高(P<0.001);感染组患者的PCT、TNF-α、hs-CRP、IL-6表达水平均高于未感染组,差异均有统计学意义(P<0.001),感染组的PCT、TNF-α、hs-CRP、IL-6表达水平随感染情况加重而提高(P<0.001)。结论原发性肺癌患者在放疗后发生肺部感染后Cdyn、RAW、Pmean和Fres等呼吸指标差,TNF-α、hs-CRP、IL-6、PCT等炎症因子高表达,提示应在肺癌放疗后严密监测上述各项指标,及时采取医疗措施,以降低肺部感染的发生率。

OBJECTIVE To investigate the changes of respiratory indexes and serum inflammatory factors in patients of primary lung cancer with pulmonary infection after radiotherapy. METHODS A total of 120 patients with primary lung cancer, who underwent radiotherapy in the Department of Respiratory and Critical Care Medicine Affiliated Hospital of Inner Mongolia Medical University from August 2015 to September 2018. All patients were divided into infected group and uninfected group according to whether the patient had pulmonary infection after radiotherapy or not. In the infected group, 52 patients were infected after radiotherapy: 14 patients with mild pulmonary infection, 25 patients with moderate pulmonary infection and 13 patients with severe pulmonary infection. In the uninfected group, 68 patients of primary lung cancer did not get pulmonary infection after radiotheraphy. The levels of serum inflammatory factors, such as procalcitonin(PCT), hypersensitive C-reactive protein(hs-CRP), interleukin 6(IL-6) and tumor necrosis factor α(TNF-α) were compared between the two groups. At the same time, the relative respiratory indexes, including dynamic compliance(Cdyn) and air way resistance(RAW), mean pressure(Pmean) and response frequency(Fres) among patients with different infection levels and between the two groups were compared. RESULTS The Cdyn level in the infected group was significantly lower than that in the uninfected group(P<0.001). The RAW, Pmean, and Fres levels in the infected group were significantly higher than that in the uninfected group(P<0.001). The level of Cdyn in the infected group significantly decreased with the increased severity of infection(P<0.001). The levels of PCT, TNF-α, hs-CRP and IL-6 in the infected group were significantly higher than that in the uninfected group(P<0.001), and significantly increased with the increased severity of infection(P<0.001). CONCLUSION In patients with primary lung cancer, the respiratory indexes such as Cdyn, RAW, Pmean and Fres were poor after pulmonary infection, and inflammatory factors such as TNF-α, hs-CRP, IL-6 and PCT were highly expressed. It suggested that after lung cancer radiotheraphy, the above indicators should be closely monitored so as to take medical intervention timely to reduce the incidence of lung infection.