老年肺癌切除术后肺部感染病原学及外周血 TLR4/NF-κB信号通路水平变化

Etiological characteristics of postoperative pulmonary infection and changes of peripheral blood TLR4/NF-кB ignaling pathways in elderly patients undergoing lung cancer resection

目的 调查老年肺癌切除术后肺部感染病原菌分布,并探究外周血Toll样家族受体-4(TLR4)/核因子κB(NF-κB)信号通路水平变化。方法 选取2019年1月-2021年12月湖州市中心医院收治的97例老年肺癌切除术后肺部感染患者为感染组,另选取同期60例术后未发生肺部感染患者为非感染组、60名老年健康体检者为对照组。采用荧光定量聚合酶链式反应法检测外周血单个核细胞TLR4/NF-κB信号通路表达,绘制受试者工作特征曲线(ROC)探究TLR4/NF-κB信号通路表达诊断肺部感染的临床价值。结果 97例肺部感染患者共分离病原菌126株,其中革兰阴性菌79株占62.70%、革兰阳性菌36株占28.57%、真菌11株占8.73%;感染组、非感染组外周血TLR4 mRNA、NF-κB mRNA表达均高于对照组(P<0.05),且感染组表达均高于非感染组(P<0.05);外周血TLR4 mRNA、N-κBmRNA诊断老年肺癌切除术后肺部感染的ROC曲线下面积为0.845、0.795。结论 老年肺癌切除术后肺部感染病原菌以革兰阴性菌为主,外周血TLR4/NF-κB信号通路表达明显上调,并对肺部感染有一定的诊断价值。

OBJECTIVE To investigate the distribution of pathogens isolated from elderly lung cancer patients with nosocomial infection after resection and explore the changes of peripheral blood Toll-like family receptor-4(TLR4)/nuclear factor κB(NF-κB) signaling pathways.METHODS From Jan 2019 to Dec 2021,totally 97 elderly patients with lung cancer who underwent resection and had postoperative pulmonary infection were assigned as the infection group,meanwhile,60 patients who did not have postoperative infection were chosen as the no infection group,and 60 healthy elderly patients who received physical examination were set as the control group.The expression level of peripheral blood mononuclear cell TLR4/NF-κBsignaling pathways was detected by fluorescence quantitative polymerase chain reaction,and the clinical value of TLR4/NF-κB signaling pathway in diagnosis of pulmonary infection was explored by means of receiver operating characteristic(ROC) curve.RESULTS Totally 126 strains of pathogens were isolated from 97 patients with pulmonary infection,79(62.70%) of which were gram-negative bacteria,36(28.57%) were gram-positive bacteria,and 11(8.73%) were fungi.The expression levels of peripheral blood TLR4 mRNA and NF-κB mRNA of the infection group and the no infection group were significantly higher than those of the control group(P<0.05),which were significantly higher in the infection group than in the no infection group(P<0.05).The areas under ROC curves(AUCs) of the peripheral blood TLR4 mRNA and NF-κB mRNA were respectively 0.845 and 0.795 in diagnosis of postoperative pulmonary infection in the elderly patients undergoing lung cancer resection.CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the elderly lung cancer patients with postoperative pulmonary infection,the expression of peripheral blood TLR4/NF-κB signaling pathway is remarkably upregulated,and it has certain value in diagnosis of pulmonary infection.