老年肝癌患者介入术后医院感染危险因素及MFG-E8、MMP-13、AFP诊断价值

Risk factors for postoperative nosocomial infection in elderly liver cancer patients receiving interventional therapy and diagnostic values of MFG-E8,MMP-13 and AFP

目的探讨老年肝癌患者介入术后医院感染危险因素及血清乳脂球表皮生长因子-8(MFG-E8)、基质金属蛋白酶-13(MMP-13)及甲胎蛋白(AFP)的诊断价值.方法选择2020年4月-2022年4月南阳医学高等专科学校第一附属医院介入科收治的166例肝癌行介入治疗的老年患者,根据术后是否并发感染分为感染组48例、非感染组118例,多因素logistic回归分析肝癌介入术后感染发生的危险因素,采用酶联免疫吸附法(ELISA)检测患者术前、术后24、48、72 h血清MFG-E8、MMP-13、AFP水平,采用受试者工作特征(ROC)曲线分析上述指标预测术后感染的价值.结果多因素logistic回归分析显示:年龄、糖尿病,术前白蛋白、血红蛋白水平是老年肝癌患者介入术后感染的危险因素(P<0.05);术后24、48、72 h MFG-E8、MMP-13水平均呈逐渐升高趋势(P<0.05),AFP水平呈逐渐降低趋势(P<0.05),且感染组MFG-E8低于非感染组(P<0.05),MMP-13、AFP高于非感染组(P<0.05);术后24 h MFG-E8、MMP-13、AFP联合预测术后感染的曲线下面积(AUC)为0.903,灵敏度为92.42%,特异度为88.73%.结论高龄、糖尿病及营养状况差可增加老年肝癌介入术后感染发生风险,术后对MFG-E8、MMP-13、AFP水平动态监测,可能有助于介入术后感染发生的预测.

OBJECTIVE To explore the risk factors for postoperative nosocomial infection in the elderly liver cancer patients receiving interventional therapy and analyze the diagnostic values of serum recombinant milk fat globule EGF factor 8(MFG-E8),matrix metalloproteinase-13(MMP-13)and alpha-fetoprotein(AFP).METHODS Totally 166 elderly patients with liver cancer who received interventional therapy in the intervention department of the First Affiliated Hospital of Nanyang Medical College from Apr 2020 to Apr 2022 were enrolled in the study and were divided into the infection group with 48 cases and the non-infection group with 118 cases accosting to the status of postoperative infection.Multivariate logistic regression analysis was performed for the risk factors for the postoperative infection.The levels of serum MFG-E8,MMP-13 and AFP were detected by means of enzymelinked immunosorbent assay(ELISA)before the surgery and after the surgery for 24,48 and 72 hours.The values of the above indexes in prediction of postoperative infection were analyzed by using receiver operating characteristic(ROC)curves.RESULTS The multivariate logistic regression analysis showed that the age,diabetes melli-tus,preoperative albumin level and hemoglobin level were the risk factors for the postoperative infection in the elderly liver cancer patients receiving interventional therapy(P<0.05).The levels of MFG-E8 and MMP-13 showed upward trends after the surgery for 24,48 and 72 hours(P<0.05),while the AFP level showed downward trend(P<0.05).The MFG-E8 level of the infection group was lower than that of the non-infection group(P<0.05);the levels of MMP-13 and AFP of the infection group were higher than those of the non-infection group(P<0.05).The area under curve(AUC)of the joint detection of MFG-E8,MMP-13 and AFP 24 hours after surgery was 0.903 in prediction of the postoperative infection,with the sensitivity 92.42%,the specificity 88.73%.CONCLUSION The advanced age,diabetes mellitus and poor nutrition status may increase the risk of postoperative infection in the elderly liver cancer patients receiving interventional therapy.Dynamic monitoring of the MFG-E8,MMP-13 and AFP may facilitate the prediction of the postoperative nosocomial infection.