鼻咽癌老年患者30例病原菌感染与淋巴细胞亚群的分析

The Value of Pathogen Infection and Lymphocyte Subset Analysis in 30 Cases Elderly Patients with Nasopharyngeal Carcinoma

目的观察鼻咽癌(NPC)老年患者放疗后感染的病原菌分布,分析感染与淋巴细胞亚群的相关性。方法收集2020年1月至2022年2月赣州市肿瘤医院收治的老年NPC感染的患者30例,纳入感染组;另收集同期该院收治的老年NPC放疗后未感染的患者30例,纳入未感染组;收集感染组患者病原菌分布及药敏试验数据;检测并比较两组患者外周血淋巴细胞数量(CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞),分析NPC老年患者放疗后感染与淋巴细胞亚群的相关性。结果30例感染患者中,以呼吸道感染为主,17例;剩余依次为口腔黏膜感染、泌尿道感染、消化道感染,分别7例、4例、2例。30例感染患者共分离出54株病原菌,以革兰阴性菌为主,共35株,占64.81%;其中以铜绿假单胞菌、肺炎克雷伯菌为主,分别14株、10株;主要病原菌对磺胺甲唑/甲氧苄啶耐药率最高,对阿米卡星耐药率最低。放疗后,两组CD3^(+)、CD4^(+)显著下降,且感染组低于未感染组;两组CD8^(+)显著升高,且感染组高于未感染组,差异有统计学意义(P<0.05);经Logistic回归分析,结果显示,CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞亚群水平与NPC老年患者放疗后感染有关(P<0.05)。结论NPC老年患者放疗后感染以呼吸道为主,病原菌主要为革兰阴性菌,对磺胺甲唑/甲氧苄啶耐药率最高;放疗后患者CD3^(+)、CD4^(+)水平显著下降,CD8^(+)升高,且淋巴细胞亚群水平与NPC老年患者放疗后感染有关。

Objective To observe the distribution of pathogenic bacteria after radiotherapy in elderly patients with nasopharyngeal carcinoma(NPC),and to analyze the correlation between infection and lymphocyte subsets.Methods 30 elderly patients with NPC infection who were admitted to Ganzhou Cancer Hospital from January 2020 to February 2022 were collected and included in the infection group;another 30 elderly patients with NPC who were treated in hospital during the same period without infection after radiotherapy were collected and included in the uninfected group.The distribution of pathogenic bacteria and drug susceptibility test data in the infection group were collected;the number of peripheral blood lymphocytes(CD3^(+),CD4^(+),CD8^(+)T lymphocytes)in the two groups of patients was detected and compared,and the relationship between infection and lymphocyte subsets in elderly patients with NPC after radiotherapy was analyzed.Results Among the 30 infected patients,respiratory tract infection was the main one,accounting 17 cases;the rest were oral mucosal infection,urinary tract infection,and digestive tract infection,with 7,4,and 2 cases,respectively.A total of 54 strains of pathogenic bacteria were isolated from 30 infected patients,mainly gram-negative bacteria,with a total of 35 strains,accounting for 64.81%;among them,pseudomonas aeruginosa and klebsiella pneumoniae were the main strains,with 14 strains and 10 strains respectively;the main pathogens had the highest resistance rate to sulfamethoxazole/trimethoprim,and the lowest resistance rate to amikacin.After radiotherapy,the CD3^(+)and CD4^(+)of the two groups decreased significantly,and the infection group was lower than the uninfected group;the CD8^(+)of the two groups increased significantly,and the infection group was higher than the uninfected group,with statistical difference(P<0.05);after logistic regression analysis,the results showed that the levels of CD3^(+),CD4^(+),and CD8^(+)T lymphocyte subsets were associated with infection after radiotherapy in elderly patients with NPC(P<0.05).Conclusion:The infection of elderly patients with NPC after radiotherapy is mainly in the respiratory tract,and the pathogenic bacteria are mainly gram-negative bacteria,and the resistance rate to sulfamethoxazole/trimethoprim is the highest.Lymphocyte subset levels are associated with post-radiotherapy infection in elderly patients with NPC.