膀胱癌患者术后尿路感染免疫状态与炎症介质的变化

Changes of immune status and inflammatory mediators in the postoperative urinary tract infection of patients with bladder cancer

目的了解膀胱癌患者术后尿路感染的免疫状态及炎症介质的变化情况。方法回顾性选取2015年9月至2017年7月咸阳市第一人民医院泌尿外科收治的57例行膀胱癌电切术后感染的患者作为观察组,另随机选取同时段的膀胱癌电切术后未发生感染的57例患者作为对照组。分析观察组患者的病原菌类型(革兰阴性菌、革兰阳性菌),并比较两组患者的免疫功能(包括细胞免疫、红细胞免疫)和炎症指标[白细胞介素1β(IL-1β)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α(NF-α)、前列腺素E2 (PGE2)。结果观察组患者术后感染的病原菌类型主要为革兰阴性菌,革兰阴性菌又以大肠埃希菌居多;观察组患者细胞免疫中的CD4^+、CD3^+CD4^+、CD4^+/CD8^+分别为(35.37±3.32)%、(4.68±0.45)%、(1.33±0.14),明显低于对照组的(41.48±3.72)%、(8.1±0.85)%、(1.73±0.18),CD8^+为(28.01±3.3)%,明显高于对照组的(21.22±2.5)%,差异均有统计学意义(P<0.05);观察组患者红细胞免疫中的自然肿瘤红细胞花环率(NTER)、协同肿瘤红细胞花环率(ATER)、促肿瘤红细胞花环率(ETER)、直向肿瘤红细胞花环率(DTER)分别为(1.42±0.23)%、(50.11±5.11)%、(33.3±4.67)%、(29.52±3.29)%,明显高于对照组的(2.25±0.41)%、(62.57±5.85)%、(45.59±5.2)%、(38.86±3.82)%,差异均有统计学意义(P<0.05;观察组患者的IL-1β、IL-6、TNF-α、PGE2表达水平分别为(2.71±0.41) pg/mL、(7.75±0.69) pg/mL、(1.31±0.18) pg/mL、(145.7±14.67) ng/mL,明显高于对照组的(1.2±0.24) pg/mL、(3.56±0.45) pg/mL、(0.88±0.16) pg/mL、(102.65±10.74) ng/mL,差异均有统计学意义(P<0.05)。结论相比于膀胱癌术后未感染患者,感染患者免疫功能显著下降、炎性因子显著升高。

Objective To explore the changes of immune status and inflammatory mediators in the postoperative urinary tract infection of patients with bladder cancer.Methods From September 2015 to July 2017,57 patients with postoperative infection of bladder cancer admitted to Department of Urology,the First People's Hospital of Xianyang were retrospectively selected as the observation group,and another 57 patients without postoperative infection of bladder cancer at the same time were selected as the control group.Pathogenic bacteria types(gram-negative bacteria and gram-positive bacteria)in the observation group were analyzed,and the immune functions(including cellular immunity and erythrocyte immunity)and inflammatory indicators including interleukin-1 beta(IL-1β),interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),prostaglandin E2(PGE2)in the two groups were compared.Results The main pathogens in the observation group were Gram-negative bacteria,and CD4^+,CD3^+CD4^+and CD4^+/CD8^+were(35.37±3.32)%,(4.68±0.45)%and(1.33±0.14)%,respectively,which were significantly lower than corresponding(41.48±3.72)%,(8.1±0.85)%and(1.73±0.18)%in the control group(all P<0.05);CD8+in the observation group was(28.01±3.3)%versus(21.22±2.5)%in the control group(P<0.05);the values of natural tumor erythrocyte rosette(NTER),associated tumor erythrocyte rosette(ATER),enhance tumor erythrocyte rosette(ETER),direct tumor erythrocyte rosette(DTER)in the observation group were(1.42±0.23)%,(50.11±5.11)%,(33.3±4.67)%,(29.52±3.29)%,respectively,which were significantly higher than corresponding(2.25±0.41)%,(62.57±5.85)%,(45.59±5.2)%,(38.86±3.82)%in the control group(all P<0.05).In the comparison of inflammatory factors,the expression levels of IL-1β,IL-6,TNF-α,and PGE2 in the observation group were(2.71±0.41)pg/mL,(7.75±0.69)pg/mL,(1.31±0.18)pg/mL,(145.7±14.67)ng/mL,respectively,which were significantly higher than corresponding(1.2±0.24)pg/mL,(3.56±0.45)pg/mL,(0.88±0.16)pg/mL,(102.65±10.74)ng/mL in the control group(all P<0.05).Conclusion Compared with uninfected patients after bladder cancer surgery,the immune function of infected patients decreased significantly,and inflammatory factors increased significantly.