术前肺功能、术后sTREM-1、小野寺指数诊断NSCLC患者术后肺部感染的价值

The Value of Preoperative Lung Function, Postoperative sTREM- 1 and Onodera Index in the Diagnosis of Postoperative Lung Infection in Patients with NSCLC

目的探讨术前肺功能指标、术后血清髓样细胞触发受体-1(sTREM-1)、小野寺指数诊断非小细胞肺癌(NSCLC)患者术后肺部感染的价值及其相关性。方法本研究采取回顾性研究方案,选取我院2019年1月至2022年1月在我院实施单孔胸腔镜手术治疗且发生术后肺部感染的患者45例(感染组)、另外选取45例同期肺部手术且未发生术后肺部感染的患者作为对照组,对比两组患者术前肺功能指标、术后血清sTREM-1、小野寺指数、C反应蛋白(CRP)、降钙素原(PCT)、患者的一般临床特征及病理学指标等,采用受试者工作特征曲线(ROC)分析术前肺功能指标、术后血清sTREM-1、小野寺指数预测诊断患者发生肺部感染的价值,采用多因素数学模型分析各项指标与患者发生肺部感染的关系。结果感染组患者的FEV1pred、PEFpred、小野寺指数均低于对照组,感染组患者的血清sTREM-1、CRP、PCT水平显著高于对照组,差异均具有统计学意义(P<0.05);以患者术前FEV1pred、PEFpred、术后小野寺指数、血清sTREM-1、CRP、PCT水平分别绘制ROC曲线,结果显示上述指标预测NSCLC患者术后发生肺部感染的ROC曲线下面积AUC值分别为0.759(0.659~0.859)、0.694(0.588~0.800)、0.915(0.846~0.984)、0.876(0.794~0.958)、0.858(0.780~0.936)和0.831(0.742~0.919);Logistic回归模型结果显示,患者年龄、sTREM-1水平增高、CRP水平增高、PCT水平增高合并COPD、肺叶切除的方式是NSCLC患者发生肺部感染的危险因素(OR均>1,P<0.05),即会增大NSCLC患者发生肺部感染的风险;而术前FEV1pred水平、PEFpred水平、小野寺指数水平是NSCLC患者发生肺部感染的保护因素(OR均<1,P<0.05),即其水平越高,越能降低NSCLC患者发生肺部感染的风险。结论术前肺功能指标、术后血清sTREM-1、小野寺指数均对NSCLC患者术后肺部感染具有一定的预测价值,其中血清sTREM-1、小野寺指数预测价值较高,同时术前肺功能受损、血清sTREM-1增高、小野寺指数降低与患者术后发生肺部感染有关。

Objective To investigate the value of preoperative pulmonary function index,postoperative serum myeloid cell trigger receptor-1(sTREM-1)and Onomi index in the diagnosis of postoperative pulmonary infection in patients with non-small cell lung cancer(NSCLC)and their correlations.Methods In this study,a retrospective study plan was adopted for the research project.Forty five patients who had undergone single holethoracoscopic surgery in our hospital from June,2019 to January,2022 and had postoperative pulmonary infection were selected as the infection group.In addition,45 patients with lung surgery at the same time with no postoperative pulmonary infection were selected as the control group matched with age and sex.The preoperative pulmonary function indicators,postoperative serum sTREM-1,Onomi index,as well as the general clinical characteristics and pathological indicators of these patients were analyzed by using the receiver operating characteristic curve(ROC)to evaluate the value of preoperative pulmonary function indicators,postoperative serum sTREM-1,and Onomi index in predicting the diagnosis of pulmonary infection.The relationship between various indicators and pulmonary infection in patients was also analyzed by using a multifactor mathematical model.Results Levels of FEV1pred,PEFpred and Onodera index in the infected group were lower than those in the control group,while levels of serum sTREM-1,CRP and PCT in the infected group were significantly higher than those in the control group(P<0.05).Preoperative FEV1pred,PEFpred,postoperative Onodera index,serum sTREM-1,CRP,and PCT levels were evaluated by ROC curves,respectively.The results showed that AUC values for predicting postoperative pulmonary infection in patients with NSCLC were 0.759(0.659-0.859),0.694(0.588-0.800),0.915(0.846-0.984),0.876(0.794-0.958),0.858(0.780-0.936)and 0.831(0.742-0.919),respectively;Logistic regression model showed that patients’age,increased sTREM-1 level,increased CRP level,increased PCT level combined with COPD and lobectomy were risk factors for pulmonary infection in NSCLC patients(OR>1,P<0.05),which would increase the risk of pulmonary infection.The preoperative level of FEV1pred,PEFpred and Onodera index were protective factors for lung infection in patients with NSCLC(OR<1,P<0.05).Conclusion Preoperative pulmonary function index,postoperative serum sTREM-1 and Onomi index all have certain predictive values for postoperative pulmonary infection in NSCLC patients.Serum sTREM-1 and Onomi index have higher predictive value,while preoperative pulmonary function impairment,serum sTREM-1 increase and Onomi index decrease are related to postoperative pulmonary infection.