结肠癌术后感染危险因素及癌组织TLR4、血清内毒素的预测价值

Risk factors for postoperative infection in colon cancer patients and predictive values of cancer tissue TLR4 and serum endotoxin

目的探讨结肠癌术后感染的危险因素及癌组织Toll样受体4(TLR4)、血清内毒素(ETX)的预测价值。方法选取2019年3月-2021年3月中国人民解放军第81集团军医院100例结肠癌术后感染患者为感染组,另取同期100例结肠癌术后未发生感染患者为未感染组。分析结肠癌术后感染患者病原菌分布情况;采用Logistic回归模型分析结肠癌术后感染的危险因素;两组均于术后采集肿瘤组织标本并测定结肠癌组织中TLR4 mRNA,同时检测两组血清ETX水平,采用受试者工作特征(ROC)曲线评价结肠癌组织TLR4 mRNA、血清ETX水平对结肠癌患者术后感染的预测价值。结果100例结肠癌术后感染患者共分离出病原菌129株,其中84株革兰阴性菌(65.12%)。Logistic回归分析结果显示,体质量指数(BMI)≥24 kg/m^(2)、糖尿病、开腹手术、手术时间≥1.5 h、白蛋白<35 g/L、住院时间≥10 d均为影响结肠癌患者术后感染的危险因素;感染组结肠癌组织TLR4 mRNA、血清ETX水平均高于未感染组(P<0.05);结肠癌组织TLR4 mRNA、血清ETX水平联合预测结肠癌患者术后感染的曲线下面积(AUC)高于两者单独预测(P<0.05)。结论结肠癌术后感染患者病原菌分布以革兰阴性菌为主,BMI、糖尿病、手术方式、手术时间、白蛋白、住院时间均为影响因素,患者癌组织TLR4表达及血清ETX水平均升高,两者有望成为预测结肠癌患者术后感染的参考指标。

OBJECTIVE To explore the risk factors for postoperative infection in colon cancer patients and analyze the predictive values of cancer tissue Toll-like receptor 4(TLR4)and serum endotoxin(ETX).METHODS From Mar 2019 to Mar 2021,totally 100 colon cancer patients who had postoperative infection in the 81st Group Military Hospital of Chinese People’s Liberation Army were enrolled in the study and assigned as the infection group,meanwhile,100 colon cancer patients who did not have postoperative infection were chosen as the no infection group.The distribution of pathogens isolated from the colon cancer patients with postoperative infection was observed.Multivariate logistic regression analysis was performed for the risk factors for postoperative infection.The cancer tissue specimens were collected from the two groups of patients after surgery so as to determine TLR4 mRNA in the colon cancer tissues,the serum ETX level was detected,and the values of colon cancer tissue TLR4 mRNA and serum ETX in prediction of postoperative infection were evaluated by receiver operating characteristic(ROC)curves.RESULTS Totally 129 strains of pathogens were isolated from the 100 colon cancer patients with postoperative infection,84(65.12%)of which were gram-negative bacteria.The result of logistic regression analysis showed that body mass index(BMI)no less than 24 kg/m^(2),diabetes mellitus,laparotomy,operation duration no less than 1.5 hours,albumin level less than 35 g/L and length of hospital stay no less than 10 days were the risk factors for the postoperative infection in the colon cancer patients.The levels of colon cancer tissue TLR4 mRNA and serum ETX of the infection group were higher than those of the no infection group(P<0.05).The area under curve(AUC)of the joint detection of colon cancer tissue TLR4 mRNA and serum ETX was larger than that of the single detection of the two indexes(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the colon cancer patients with postoperative infection.BMI,diabetic diabetes,mode of surgery,operation duration,albumin and length of hospital stay are the influencing factors.The patients show the rise of levels of both cancer tissue TLR4 and serum ETX,and the two indexes are supposed to be used as reference indexes for prediction of postoperative infection in the colon cancer patients.