不同分期宫颈癌淋巴细胞亚群与炎症因子及术后感染比较

Comparisons of lymphocyte subgroups, inflammatory factors and postoperative infections in different stages of cervical cancer

目的对比分析不同分期宫颈癌患者淋巴细胞亚群、炎症因子水平及术后感染情况,为术后感染的预防和控制工作提供研究参考。方法选取2016年1月-2020年1月于青海省人民医院接受根治术治疗的92例宫颈癌患者作为研究对象。对不同临床分期患者的年龄、体质量指数、合并基础疾病、淋巴结转移情况、手术方式等进行调查和分析。对不同临床分期患者术前的外周血CD_3~+T淋巴细胞比例、CD^(+)_(4)T淋巴细胞比例、CD^(+)_(8)T淋巴细胞比例、CD^(+)_(4)/CD^(+)_(8)T淋巴细胞比值、辅助性T细胞17(Th17)比例、调节性T细胞(Treg)比例、Th17/Treg比值及血清白细胞介素-2(IL-2)、IL-4、IL-13、IL-17、干扰素-γ(IFN-γ)进行比较;比较不同临床分期患者的术后感染情况。结果Ⅰ期患者出现淋巴结转移的比例低于Ⅱ期患者(P<0.05)。Ⅰ期患者术前外周血CD_3~+T、CD^(+)_(4)T、CD^(+)_(4)/CD^(+)_(8) T分别为(63.35±6.55)%、(32.06±4.83)%、(1.18±0.19)均高于Ⅱ期患者,外周血Th17比例、Treg比例、Th17/Treg比值分别为(2.96±1.22)%、(4.31±1.29)%、(0.65±0.12)均低于Ⅱ期患者(P均<0.001)。Ⅰ期患者术前血清IL-2、IFN-γ水平分别为(206.81±25.18)ng/L、(17.75±1.86)μg/ml,均高于Ⅱ期患者,血清IL-4、IL-17、IL-23水平分别为(213.68±26.35)ng/L、(183.35±23.71)pg/ml、(113.25±12.58)pg/ml均低于Ⅱ期患者P<0.001)。Ⅰ期患者术后感染率(5例,12.20%)低于Ⅱ期患者(15例,29.41%)(P<0.05),其中,Ⅰ期患者的术后感染部位以手术部位为主,而Ⅱ期患者的术后感染部位以泌尿系统为主。结论不同临床分期宫颈癌患者术前免疫炎症状态和术后感染情况具有显著的差异,临床分期较高的患者的免疫功能紊乱和炎症损害更加严重,术后感染率更高,感染部位更加多样,临床应在术前对患者的病情和免疫炎症状态进行准确的评价,从而有针对性地预防术后感染的发生。

OBJECTIVE To compare and analyze the lymphocyte subgroups,inflammatory factors levels and postoperative infections in patients with different stages of cervical cancer,so as to provide research basis for prevention and control of postoperative infections.METHODS A total of 92 patients with CC who received radical mastectomy in the People′s Hospital of Qinghai Provincial from Jan.2016 to Jan.2020 were selected as the research subjects.The age,the body mass index,the basic diseases,lymph node metastasis and the operation methods of patients with different clinical stages were investigated and analyzed.Peripheral blood CD3+T lymphocyte ratio,CD^(+)_(4)T lymphocyte ratio,CD^(+)_(8)T lymphocyte ratio,CD^(+)_(4)/CD^(+)_(8)T lymphocyte ratio,T helper cell 17(Th17)ratio,T regulator T cell(Treg)ratio,Th17/Treg ratio and serum interleukin(IL)-2,IL-4,IL-13,IL-17,interferon(IFN)-γof patients with different clinical stages before operation were compared.The postoperative infections of patients with different clinical stages were compared.RESULTS The proportion of lymph node metastasis of the patients in stage I was lower than that of patients in stage II.The peripheral blood CD3+T lymphocyte,CD^(+)_(4)T lymphocyte,and CD^(+)_(4)/CD^(+)_(8)T lymphocyte ratio of the patients in stage I before operation were(63.35±6.55)%,(32.06±4.83)%,and(1.18±0.19),respectively,higher than those of the patients in stage II.The peripheral blood Th17 ratio,Treg ratio,Th17/Treg ratio of the patients in stage I were(2.96±1.22)%,(4.31±1.29)%,and(0.65±0.12)respectively,significantly lower than those of the patients in stage II(P<0.001).The preoperative serum IL-2 and IFN-γlevels of patients in stage I were(206.81±25.18)ng/L and(17.75±1.86)μg/ml,respectively,significantly higher than those of the patients in stage II.The serum levels of IL-4,IL-17 and IL-23 were(213.68±26.35)ng/L,(183.35±23.71)pg/ml and(113.25±12.58)pg/ml,respectively,significantly lower than those of the patients in stage II(P<0.001).The postoperative infection rate of stage I patients(5 cases,12.20%)was significantly lower than that of stage II patients(15 cases,29.41%)(P<0.001).Among them,the postoperative infection site of stage I patients was mainly the surgical site,while the infection site of stage II patients was mainly urinary system.CONCLUSION There were significant differences in the preoperative immune inflammatory status and postoperative infections of CC patients with different clinical stages.The patients with higher clinical stage had more severe immune dysfunction and inflammatory damage,higher incidence of postoperative infections and more diverse infection sites.Clinically,the patient′s condition and immune inflammatory status should be accurately evaluated before the operation,so as to prevent the occurrence of postoperative infections purposefully.