食管癌术后并发肺部感染病原菌分布及与患者血清TNF-α IL-1β IL-8的关系

Distribution of Pathogenic Bacteria of Pulmonary Infection after Esophageal CancerSurgery and Relationship with Serum TNF-α IL-1β and IL-8 of Patients

目的:探究食管癌术后并发肺部感染病原菌分布及与患者血清肿瘤坏死因子-α(TNF-α),白细胞介素-1β(IL-1β)及白细胞介素-8(IL-8)的关系。方法:选取2020年1月至2021年1月我院收治的98例择期行胸腔镜下食管癌根治术患者作为研究对象,根据术后肺部感染情况分为感染组32例和未感染组66例;按照肺部感染程度CURB-65评分标准将肺部感染患者分为轻度组14例、中度组11例及重度组7例。分析感染组患者病原菌分布情况;采集所有患者术后外周血标本,采用酶联免疫吸附法检测肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-8(IL-8)水平;采用多因素Logistic回归分析食管癌术后并发肺部感染的危险因素;采用Spearman等级相关分析上述炎症因子与CURB-65评分的相关性。结果:32例感染患者共分离出病原菌44株,革兰阴性菌株26(59.09%),革兰阳性菌株15(34.09%),真菌株3(6.82%);感染组患者中有长期吸烟史、糖尿病、肿瘤位于上/中段、CURB-65评分>2分的占比长于高于未感染组(P<0.05);感染组血清TNF-α、IL-1β及IL-8水平均高于未感染组(P<0.05);重度组患者血清TNF-α、IL-1β及IL-8水平均高于轻度组及中度组,中度组患者血清TNF-α、IL-1β及IL-8水平均高于轻度组(P<0.05);多元Logistic回归分析显示,长期吸烟史、合并糖尿病、肿瘤位于上/中段、CURB-65评分>2分、TNF-α≥7.44μg/L、IL-1β≥38.21μg/L、IL-8≥34.25μg/L是食管癌术后患者并发肺部感染的危险因素(P <0.05);肺部感染患者的血清TNF-α、IL-1β及IL-8水平均与CURB-65评分呈正相关(r=0.516、0.589、0.536,P<0.05)。结论:食管癌术后肺部感染患者的血清TNF-α、IL-1β及IL-8呈高表达水平,且血清TNF-α、IL-1β及IL-8水平与肺部感染严重程度密切相关,临床可通过检测血清TNF-α、IL-1β及IL-8水平评估患者食管癌术后肺部感染的发生及发展情况。

Objective:To explore the distribution of pathogenic bacteria of pulmonary infection after esophageal cancer surgery and relationship with serum TNF-α,IL-1βand IL-8 of patients.Methods:98 patients with elective thoracoscopic radical resection of esophageal cancer in the hospital between January 2020 and January 2021 were selected as the research subjects.According to postoperative pulmonary infection,the patients were divided into the infected group(32 cases)and uninfected group(66 cases).According to the CURB-65 scoring standard for the pulmonary infection degree,the patients with pulmonary infection were classified into mild group(14 cases),moderate group(11 cases)and severe group(7 cases).The distribution status of pathogenic bacteria in infected group were analyzed.Postoperative peripheral blood samples were collected from all patients,and enzyme-linked immunosorbent assay was used to detect the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and interleukin-8(IL-8).Multivariate logistic regression analysis of risk factors for postoperative pulmonary infection in patients with esophageal cancer.Spearman rank correlation analysis was applied to analyze the correlation between the above inflammatory factors and CURB-65 score.Results:44 strains of pathogenic bacteria were isolated from 32 infected patients,including 26 strains(59.09%)of Gram-negative strains,15 strains(34.09%)of Gram-positive strains and 3 strains(6.82%)of fungi.The proportions of patients with long-term smoking history,diabetes mellitus,tumors located in the upper/middle segment and CURB-65 score>2 in infected group were higher than those in uninfected group(P<0.05).The levels of serum TNF-α,IL-1βand IL-8 were higher in infected group than those in uninfected group(P<0.05).Serum levels of TNF-α,IL-1βand IL-8 were higher in severe group than those in mild group and moderate group,and were higher in moderate group than those in mild group(P<0.05).Multivariate Logistic regression analysis showed that long-term smoking history,diabetes mellitus,tumor located in the upper/middle segment,CURB-65 score>2 points,TNF-α≥7.44μg/L,IL-1β≥38.21μg/L and IL-8≥34.25μg/L were risk factors for pulmonary infection in patients after esophageal cancer surgery(P<0.05).Serum TNF-α,IL-1βand IL-8 levels in patients with pulmonary infection were positively correlated with CURB-65 score(r=0.516,0.589,0.536,P<0.05).Conclusion:Serum TNF-α,IL-1βand IL-8 are highly expressed in patients with pulmonary infection after esophageal cancer surgery,and the levels of serum TNF-α,IL-1βand IL-8 are closely related to the severity of pulmonary infection.The occurrence and development of postoperative pulmonary infection in patients with esophageal cancer can be assessed clinically by detecting the levels of serum TNF-α,IL-1βand IL-8.