胃癌根治术后手术部位感染影响因素及血清MCP1、CA72-4、sCD14水平变化意义分析

Analysis of the influencing factors of surgical site infection and the changes of serum MCP1,CA72-4 and sCD14 levels after radical resection of gastric cancer

目的:探究胃癌根治术后手术部位感染(surgical site infection,SSI)影响因素及血清单核细胞趋化蛋白-1(monocyte chemoattractant protein-1,MCP1)、糖类抗原72-4(carbohydrate antigen 72-4,CA72-4)、可溶性白细胞分化抗原-14(soluble cluster of differentiation antigen-14,sCD14)水平变化意义。方法:选取2017年02月至2021年01月我院150例行胃癌根治术患者作为研究对象,根据患者术后是否出现SSI分为两组,感染组(n=35)与非感染组(n=115)。比较两组患者临床资料、手术前后血清MCP1、CA72-4、sCD14水平,分析胃癌根治术后SSI影响因素。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),评价胃癌根治术后血清MCP1、CA72-4、sCD14水平对SSI的诊断价值。分析术后血清MCP1、CA72-4、sCD14水平与感染程度(IPS评分)的相关性。比较术后血清MCP1、CA72-4、sCD14高水平与低水平患者病死率。结果:两组患者年龄、手术方式、临床分期、手术时间、糖尿病情况比较,差异有统计学意义(P<0.05)。感染组术后血清MCP1、CA72-4、sCD14水平高于非感染组(P<0.05)。Logistic回归方程结果显示,年龄、临床分期、糖尿病、手术方式、手术时间及术后血清MCP1、CA72-4、sCD14水平均为胃癌根治术后SSI的独立危险因素(P<0.05)。绘制胃癌根治术后血清MCP1、CA72-4、sCD14水平对SSI诊断价值的ROC曲线,结果显示胃癌根治术后血清MCP1、CA72-4、sCD14水平诊断SSI的曲线下面积(area under the curve,AUC)分别为0.804、0.768、0.777。应用Logistic二元回归拟合,构建各指标联合诊断的AUC,结果显示,联合检测的AUC为0.912。胃癌根治术后SSI患者IPS评分为(13.89±6.52)分。Pearson相关性分析可知,胃癌根治术后SSI患者血清MCP1、CA72-4、sCD14水平与感染程度呈正相关关系(P<0.05)。根据术后血清MCP1、CA72-4、sCD14水平分为高水平组与低水平组,术后血清MCP1、CA72-4、sCD14高水平组病死率明显高于低水平组,差异有统计学意义(P<0.05)。结论:胃癌根治术后SSI发病影响因素包括年龄、临床分期、糖尿病、手术方式、手术时间及术后血清MCP1、CA72-4、sCD14水平,且临床检测术后血清MCP1、CA72-4、sCD14水平,在SSI诊断、病情评估及预后预测中具有重要价值。

Objective:To explore the influencing factors of surgical site infection(SSI)after radical gastric cancer surgery and serum monocyte chemoattractant protein-1(MCP1),carbohydrate antigen 72-4(CA72-4),soluble cluster of differentiation antigen-14(sCD14)significance of level changes.Methods:A total of 150 patients undergoing radical gastric cancer surgery in our hospital from February 2017 to January 2021 were selected as the research objects.The patients were divided into two groups according to whether the patients had SSI after surgery,the infection group(n=35)and the non-infection group(n=115).Compare the clinical data of the two groups,serum MCP1,CA72-4,and sCD14 levels before and after surgery,analyze the influencing factors of SSI after radical gastric cancer and draw receiver operating characteristic curve(ROC),and evaluate the effects of serum MCP1,CA72-4 and sCD14 levels on gastric cancer.The diagnostic value of SSI after radical surgery and analyze the correlation between postoperative serum MCP1,CA72-4,sCD14 levels and the degree of infection(IPS score),and compare the mortality of patients with high and low levels of serum MCP1,CA72-4,sCD14 after surgery.Results:There were significant differences between the two groups in age,operation method,clinical stage,operation time,and diabetes(P<0.05).The postoperative serum MCP1,CA72-4,and sCD14 levels in the infected group were higher than those in the non-infected group(P<0.05).Logistic regression equation showed that age,clinical stage,diabetes,operation mode,operation time and postoperative serum levels of MCP1,CA72-4 and sCD14 were all independent risk factors for SSI after radical gastrectomy(P<0.05).The ROC curve of the diagnostic value of serum MCP1,CA72-4 and sCD14 after radical gastrectomy was drawn.The results showed that the area under curve(AUC)of serum MCP1,CA72-4 and sCD14 after radical gastrectomy was 0.804,0.768 and 0.777,respectively.Logistic binary regression fitting was used to construct the AUC of joint diagnosis of each index.The results showed that the AUC of joint detection was 0.912.The IPS score of SSI patients after radical gastrectomy was(13.89±6.52).Pearson correlation analysis showed that postoperative serum MCP1,CA72-4,sCD14 levels of SSI patients after radical gastric cancer surgery were positively correlated with the degree of infection(P<0.05).According to the postoperative serum MCP1,CA72-4,sCD14 levels for the high-level group and the low-level group,the postoperative serum MCP1,CA72-4,sCD14 high-level mortality rate was significantly higher than that of the low-level group,and the difference was statistically significant(P<0.05).Conclusion:Factors influencing the development of SSI after radical gastric cancer surgery include age,clinical stage,diabetes mellitus,surgical method,time of surgery and postoperative serum MCP1,CA72-4 and sCD14 levels,and clinical detection of postoperative serum MCP1,CA72-4 and sCD14 levels is of great value in the diagnosis,disease assessment and prognosis prediction of SSI.