肺部感染对胃癌患者术后肾素-血管紧张素-醛固酮系统的影响

Effect of pulmonary infection on renin-angiotensin-aldosterone system in the postoperative patients with gastric cancer

目的探索肺部感染对胃癌患者术后肾素-血管紧张素-醛固酮系统(Renin-angiotension-aldosterone system,RAAS)的影响。方法选取2016年2月-2019年10月于海南省三亚中心医院接受治疗的248例胃癌手术患者为研究对象,根据患者术后是否发生感染分为感染组(n=36)和未感染组(n=212)。检测并分析患者术前、术后血管紧张素(Angiotensin,Ang-Ⅱ)、去甲肾上腺素(Noradrenaline,NE)、醛固酮(aldosterone,ALD)等RAAS指标和白蛋白、总蛋白营养指标以及免疫球蛋白M(immunoglobulin M,IgM)、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白A(immunoglobulin A,IgA)免疫功能指标。结果感染组术后Ang-Ⅱ(74.69±13.26)ng/L、NE(76.21±14.39)μg/L、ALD(45.68±7.29)ng/L水平均高于未感染组,差异有统计学意义(P<0.05)。感染组术后白蛋白、总蛋白水平均低于未感染组,差异有统计学意义(P<0.05)。感染组术后IgM、IgG、IgA指标水平均低于未感染组,差异有统计学意义(P<0.05)。结论胃癌手术患者术后发生肺部感染对RAAS系统影响较大,且会导致患者术后营养状况和免疫功能下降,临床医师可以根据肺部感染患者RAAS系统指标变化情况对胃癌患者预后进行初步判断。

OBJECTIVE To explore the effect of lung infection on renin-angiotension-aldosterone system(RAAS) in patients after gastric cancer surgery. METHODS From Feb. 2016 to Oct. 2019, 248 patients with gastric cancer who were treated in Sanya Central Hospital in Hainan Province were recruited as the study objects. According to whether the patients had postoperative infection, they were divided into the infection group(n=36) and non-infection group(n=212). The preoperative and postoperative levels of angiotensin(Ang-Ⅱ), noradrenaline(NE), aldosterone(ALD), RAAS, albumin, total protein nutrition, immunoglobulin M(IgM), immunoglobulin G(IgG) and immunoglobulin A(IgA) were measured and analyzed. RESULTS The indexes of Ang-Ⅱ(74.69±13.26) ng/L, NE(76.21±14.39) μg/L, ALD(45.68±7.29) ng/L in the infected group were significantly higher than that in the uninfected group(P<0.05). Postoperative albumin and total protein levels in the infected group were significantly lower than that in the uninfected group(P<0.05). The levels of IgM, IgG and IgA in the infected group were significantly lower than that in the uninfected group(P<0.05). CONCLUSIONPostoperative pulmonary infection in patients with gastric cancer had a serious impact on the RAAS system, and can lead to the function decline of postoperative nutritional status and immune system. Clinicians can make a preliminary judgment on the prognosis of gastric cancer based on the changes of RAAS system indicators in patients with pulmonary infection.