Th1/Th2、MCP-1、sTREM-1在结直肠癌术后医院感染患者中的水平及对病原菌类型的鉴别价值

Levels of Th1/Th2,MCP-1 and s TREM-1 in Patients with Nosocomial Infection after Radical Resection for Colorectal Cancer and Their Values in Identification of Pathogen Types

目的探讨Th1/Th2、单核细胞趋化蛋白-1(MCP-1)、可溶性髓系细胞触发受体-1(sTREM-1)水平与结直肠癌(CRC)根治术后医院感染患者病原菌类型的关系。方法选取2017年5月—2020年4月行CRC根治术后医院感染45例作为感染组,另选择术后未发生医院感染的100例作为未感染组。统计2组术后医院感染病原菌分布,对比2组临床资料及手术前后Th1/Th2、MCP-1、sTREM-1水平,分析术后医院感染影响因素,对比不同病原菌感染患者Th1/Th2、MCP-1、sTREM-1水平。结果45例CRC根治术后医院感染患者共培养出45株病原菌,其中革兰阴性菌27株(60.00%)、革兰阳性菌14株(31.11%)、真菌4株(8.89%)。感染组术后Th1/Th2低于未感染组,MCP-1、sTREM-1水平高于未感染组(P<0.01)。多因素Logistic回归分析显示,引流管放置时间及术后Th1/Th2、MCP-1、sTREM-1水平均为CRC根治术后医院感染影响因素(P<0.01)。受试者工作特征曲线显示,Th1/Th2、MCP-1、sTREM-1鉴别术后医院革兰阴性菌感染的曲线下面积分别为0.817、0.751、0.747。结论CRC根治术后医院感染患者以革兰阴性菌感染为主,Th1/Th2、MCP-1、sTREM-1均是医院感染影响因素,且可用于革兰阴性菌感染鉴别。

Objective To investigate correlations between expressions of helper T lymphocyte 1(Th1)/helper T lymphocyte 2(Th2),monocyte chemoattractant protein-1(MCP-1)and soluble myeloid cell triggering receptor-1(sTREM-1)with types of pathogens in patients with nosocomial infection after radical resection for colorectal cancer(CRC).Methods A total of 45 patients with nosocomial infection after radical resection for CRC between May 2017 and April 2020 were selected as infection group,and 100 patients without nosocomial infection after surgery were selected as non-infection group.The pathogens distribution conditions of postoperative nosocomial infection were calculated,and clinical data and levels of Th1/Th2,MCP-1 and sTREM-1 before and after operation were compared in two groups.Influencing factors of postoperative nosocomial infection were analyzed,and levels of Th1/Th2,MCP-1 and sTREM-1 in patients with different pathogen infections were compared.Results A total of 45 strains of pathogens were cultured from 45 patients with nosocomial infection after radical resection for CRC,which included 27 strains of gram-negative bacteria(60.00%),14 strains of gram-positive bacteria(31.11%)and 4 strains of fungi(8.89%).In infection group,postoperative Th1/Th2 level was lower,while levels of MCP-1 and sTREM-1 were higher than those in non-infection group(P<0.01).Multivariate Logistic regression analysis showed that placement time of drainage tube and levels of Th1/Th2,MCP-1 and sTREM-1 were influencing factors of nosocomial infection after radical resection for CRC(P<0.01).Receiver operating characteristic(ROC)curve showed that areas under the ROC curve(AUC)of Th1/Th2,MCP-1 and sTREM-1 to identify postoperative nosocomial gram-negative bacterial infection were 0.817,0.751 and 0.747 respectively.Conclusion Gram-negative bacteria is the main pathogen in patients with nosocomial infection after radical resection for CRC.Th1/Th2,MCP-1 and sTREM-1 are influencing factors of nosocomial infection,which may be used for the identification of gram-negative bacteria infection.