肝癌患者肝切除术后切口细菌感染特征及免疫细胞因子水平变化

Characteristics of incision bacterial infection and changes of immune cytokines in patients with hepatocellular carcinoma after hepatectomy

目的 探讨肝癌患者肝切除术后切口细菌感染特征及免疫细胞因子水平变化。方法 选取2016年5月至2020年5月在我院接受肝切除术治疗的81例肝癌患者为研究对象,根据患者是否发生术后感染将其分为感染组(n=39)和未感染组(n=42)。对比两组患者术前、术后各时点的免疫细胞水平状况和感染组患者细菌感染特征。采用单因素和多因素Logistic分析筛选肝癌患者手术切口感染的危险因素。结果 与未感染组相比,感染组患者术后当天以及术后3 d CD3^(+)CD4^(+)、CD3^(+)CD8^(+)、CD16^(+)CD56^(+)、CD19^(+)细胞水平下降趋势更显著(均P<0.05),且同组不同时间点相比,术后各免疫细胞水平均低于术前1 d(均P<0.05)。39例术后感染患者的切口分泌物中共检测出66株病原菌,其中真菌3株,占4.54%,革兰阳性菌38株,占57.58%,革兰阴性菌25株,占37.88%。单因素、多因素Logistic分析显示,年龄>65岁(OR=2.119 5,95%CI:1.226 4~3.661 1)、血清白蛋白<35 g/L(OR=1.289 4,95%CI:1.009 3~1.647 5)、糖尿病史(OR=2.257 2,95%CI:1.110 2~4.588 2)、手术时间≥4 h(OR=3.135 6,95%CI:1.250 9~7.864 3)、出血量≥1 500 mL(OR=3.568 3,95%CI:1.311 3~9.713 9)、引流管留置时长≥7 d(OR=3.881 4,95%CI:1.445 2~10.420 8)以及住院时间≥14 d(OR=2.892 3,95%CI:1.379 4~6.067 2)均是肝切除患者术后感染的独立危险因素。结论 行肝切除术的肝癌患者术后切口感染的可能性较大,其病原菌以革兰阳性菌为主。年龄、手术时间等均是肝切除术后切口感染的危险因素。临床可根据细菌感染特征予以针对性治疗,并对危险因素进行控制,对患者的感染状况进行干预。

Objective To observe the characteristics of incision bacterial infection and the changes of immune cytokines in patients with hepatocellular carcinoma after hepatectomy. Methods A total of 81 patients with liver cancer who received hepatectomy in our hospital from May 2016 to May 2020 were selected and divided into infection group(n=39) or non-infection group(n=42) according to whether the patients had postoperative infection. The levels of immune cells and characteristics of bacterial infection were compared before and after operation. Univariate and multivariate logistic analysis were used to analyze the risk factors of surgical incision infection in patients with liver cancer. Results Compared with the non-infection group, the levels of immune cells including CD3^(+)CD4^(+), CD3^(+)CD8^(+), CD16^(+)CD56^(+) and CD19^(+) in the infection group decreased more significantly on the first and third days after operation(all P<0.05), and the levels of immune cells in the same group at different time points after operation were lower than those on the first day before operation(all P<0.05). A total of 66 strains of pathogens were detected in the wound secretion of 39 patients with postoperative infection, including 3 strains(4.54%) of fungi, 38 strains(57.58%) of Gram positive bacteria, and 25 strains(37.88%) of Gram negative bacteria. Univariate and multivariate logistic analysis showed that age >65 years(OR=2.119 5, 95% CI: 1.226 4-3.661 1), serum albumin <35 g/L(OR=1.289 4, 95% CI: 1.009 3-1.647 5), diabetes history(OR=2.257 2, 95% CI: 1.110 2-4.588 2),operation time ≥4 hours(OR=3.135 6, 95% CI: 1.250 9-7.864 3), blood loss ≥ 1 500 mL(OR=3.568 3, 95% CI: 1.311 3-9.713 9), drainage tube indwelling time ≥7 days(OR=3.881 4, 95% CI: 1.445 2-10.420 8) and hospital stay ≥14 days(OR=2.892 3, 95% CI: 1.379 4-6.067 2) were independent risk factors for postoperative infection after hepatectomy. Conclusion The possibility of incision infection after hepatectomy is relatively high, and Gram positive bacteria is the main pathogen. Age, operation time and other factors are the risk factors of incision infection after hepatectomy. According to the characteristics of bacterial infection, patients can be given targeted antibiotic treatment, and the risk factors can be controlled, so as to intervene the infection status of patients with liver cancer after hepatectomy.