胃癌患者肿瘤血液免疫指标与术后并发症的关系分析

Analysis of the relationship between tumor blood immune indexes and postoperative complications in patients with gastric cancer

目的探讨胃癌患者外周血血液免疫指标与术后发生并发症的关系。方法收集2017年7月至2020年3月在西安大兴医院普外科接受胃癌根治术的220例患者的临床资料,根据术后有无并发症分为并发症组与无并发症组。检测所有患者术前1 d外周血血红蛋白(HGB)、清蛋白(ALB)、血小板与淋巴细胞比值(PLR)、中性粒细胞与淋巴细胞比值(NLR)、调节性T淋巴细胞(Treg)、辅助性T淋巴细胞17(Th17)、C-反应蛋白(CRP)、CD3^(+)T细胞、CD4^(+)/CD8^(+)。对患者围术期指标及手术情况、临床病理特征、血液免疫指标与术后并发症发生进行比较分析,对有差异的指标采用多因素Logistic回归分析。结果220例患者术后1个月出现腹腔感染6例,腹腔出血4例,吻合口瘘4例,胃瘫10例,切口感染5例,十二指肠残端瘘1例,肺部感染15例。两组患者在手术时间、术中出血量、美国麻醉医师协会(ASA)分级中比较,差异均无统计学意义(P>0.05),在手术方式及吻合方式中比较,差异有统计学意义(P<0.05)。两组患者肿瘤最大径、TNM分期比较,差异均有统计学意义(P<0.05),在淋巴结转移、肿瘤部位及病理分型方面比较差异均无统计学意义(P>0.05)。两组患者术前1 d的HGB、ALB、PLR、NLR、Th17/Treg、CRP、CD3^(+)T细胞、CD4^(+)/CD8^(+)比较,差异均有统计学意义(P<0.05)。术前1 d的PLR≥165.9、NLR≥2.7、CRP≥9.4 g/L及Th17/Treg<28.1、CD4^(+)/CD8^(+)<1.2是胃癌患者术后并发症的独立危险因素(P<0.05)。结论胃癌患者的血液免疫指标(PLR、NLR、CRP及Th17/Treg、CD4^(+)/CD8^(+))是术后并发症的影响因素,术前检测以上血液免疫指标,可用于评估胃癌患者术后短期并发症的发生情况,从而指导个体化治疗。

Objective To investigate the relationship between peripheral blood immune indexes and postoperative complications in patients with gastric cancer.Methods The clinical data of 220 patients who underwent radical gastrectomy for gastric cancer in the department of general surgery of Xi′an Daxing Hospital from July 2017 to March 2020 were collected.According to the occurrence of postoperative complications,they were divided into a complication group and an uncomplicated group.Peripheral blood hemoglobin(HGB),albumin(ALB),platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),regulatory T lymphocytes(Treg),Helper T lymphocytes 17(Th17),C-reactive protein(CRP),CD3^(+)T cells,CD4^(+)/CD8^(+)were detected in all patients 1 day before operation.The perioperative indexes and surgical conditions,clinicopathological characteristics,blood immune indexes and postoperative complications were compared and analyzed,and multivariate Logistic regression analysis was used to analyze the differences in indexes.Results One month after operation,there were 6 cases of abdominal infection,4 cases of abdominal hemorrhage,4 cases of anastomotic leakage,10 cases of gastroparesis,5 cases of incision infection,1 case of duodenal stump fistula and 15 cases of lung infection in 220 patients.There was no significant difference in operation time,intraoperative blood loss and American Society of Anesthesiologists classification between the two groups(P>0.05),there were significant differences in operation method and anastomosis method(P<0.05).There were significant differences in the maximum tumor diameter and TNM staging between the two groups(P<0.05),there was no significant difference in lymph node metastasis,tumor location and pathological classification(P>0.05).There were significant differences in HGB,ALB,PLR,NLR,Th17/Treg,CRP,CD3^(+)T cells,CD4^(+)/CD8^(+)cells between the two groups 1 day before surgery(P<0.05).PLR≥165.9,NLR≥2.7,CRP≥9.4 g/L,Th17/Treg<28.1,CD4^(+)/CD8^(+)<1.2 were independent risk factors of postoperative complications of gastric cancer patients 1 day before operation(P<0.05).Conclusion The blood immune indexes(PLR,NLR,CRP,TH17/Treg,CD4^(+)/CD8^(+))of patients with gastric cancer are the influencing factors of postoperative complications.The detection of the above blood immune indexes before operation can be used to evaluate the occurrence of short-term postoperative complications of gastric cancer,so as to guide individualized treatment.