肺癌放疗后继发肺部感染病原菌特点及呼吸指标、血清炎性因子水平变化分析

Analysis of the distribution characteristics of pathogenic bacteria and changes in respiratory indicators and serum inflammatory factor levels in secondary pulmonary infections in lung cancer patients after radiotherapy

目的分析肺癌放疗后继发肺部感染患者的病原菌分布特点,了解呼吸指标、血清炎性因子水平变化情况。方法选取本院治疗的65例肺癌放疗后继发肺部感染者为研究对象,同时选取同期65例未发生感染的患者为对照组。采集肺部感染患者痰液或支气管肺泡灌洗液标本进行病原菌鉴定及药敏试验。检测所有患者呼吸指标(包括肺动态顺应性、气道阻力、气道平均压、响应频率)及血清炎性因子(包括降钙素原、超敏C-反应蛋白、肿瘤坏死因子-α)水平。对比肺部感染组与对照组、不同肺部感染严重程度患者的呼吸指标与血清炎性因子水平。结果共分离出65株病原菌,其中92.31%分离自呼吸道痰液标本,7.69%分离自支气管肺泡灌洗液标本。49.23%为革兰阴性菌,主要为铜绿假单胞菌、肺炎克雷伯菌、流感嗜血杆菌。27.69%为革兰阳性菌18株,主要为肺炎链球菌、金黄色葡萄球菌。23.08%为真菌,主要为白色假丝酵母菌。革兰阴性菌对环丙沙星、诺氟沙星、庆大霉素的耐药率高于50%,对哌拉西林/他唑巴坦、头孢吡肟、亚胺培南、美罗培南、阿米卡星的耐药率低于30%。革兰阳性菌对青霉素、阿莫西林、氯霉素、阿奇霉素、环丙沙星、左氧氟沙星的耐药率高于50%,未产生对万古霉素、利奈唑胺的耐药株。真菌对氟康唑、氟胞嘧啶的耐药率为13.33%,对伊曲康唑的耐药率为6.67%,未产生对两性霉素B、伏立康唑的耐药株。肺部感染组患者肺动态顺应性低于对照组,气道阻力、气道平均压、响应频率高于对照组,差异有统计学意义(P<0.05)。重度肺部感染患者肺动态顺应性低于轻度、中度感染组,气道阻力、气道平均压、响应频率高于轻度、中度感染组,差异有统计学意义(P<0.05)。肺部感染组患者血清降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)水平显著高于对照组,重度肺部感染组患者血清降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、超敏C-反应蛋白(hs-CRP)水平显著高于轻度、中度感染组,差异均有统计学意义(P<0.05)。结论肺癌放疗后继发肺部感染患者病原菌以革兰阴性菌为主,对临床常见抗菌药物的耐药率较高。肺癌放疗后继发肺部感染患者的呼吸指标变差,PCT、TNF-α、hs-CRP炎性因子水平升高,并随肺部感染严重程度加重而加大变化,临床上应做好检测与防控。

Objective To analyze the distribution characteristics of pathogenic bacteria and changes in respiratory indicators and serum inflammatory factor levels in patients with secondary lung infection after radiotherapy for lung cancer.Methods 65 patients with secondary lung infection after radiotherapy for lung cancer who were treated in our hospital were selected as the study subjects,while 65 patients who did not develop infection after radiotherapy for lung cancer during the same period were selected as the control group.The sputum or bronchoalveolar lavage fluid samples were collected from patients with pulmonary infection for pathogen identification and drug sensitivity testing.The respiratory indicators(including lung dynamic compliance,airway resistance,mean airway pressure,response frequency)and serum inflammatory factors(including procalcitonin,hypersensitive C-reactive protein,and tumor necrosis factor-α)were detected in all patients.The respiratory indicators and serum inflammatory factor levels between the pulmonary infection group and the control group were compared,as well as patients with different levels of pulmonary infection severity.Results A total of 65 pathogenic bacteria were isolated,of which 92.31%were isolated from respiratory sputum samples and 7.69%were isolated from bronchoalveolar lavage fluid samples.49.23%were Gram negative bacteria,mainly Pseudomonas aeruginosa,Klebsiella pneumoniae,and Haemophilus influenzae.27.69%were 18 strains of Gram positive bacteria,mainly Streptococcus pneumoniae and Staphylococcus aureus.23.08%were fungi,mainly Candida albicans.The resistance rate of Gram negative bacteria to ciprofloxacin,norfloxacin,and gentamicin is higher than 50%,while the resistance rate to piperacillin/tazobactam,cefepime,imipenem,meropenem,and amikacin was lower than 30%.The resistance rate of Gram positive bacteria to penicillin,amoxicillin,chloramphenicol,azithromycin,ciprofloxacin,and levofloxacin was higher than 50%,and no resistant strains to vancomycin or linezolid had been developed.The resistance rate of fungi to fluconazole and flucytosine was 13.33%,and the resistance rate to itraconazole was 6.67%.No resistant strains to amphotericin B and voriconazole had been developed.Comparing the respiratory indicators between the pulmonary infection group and the control group,the Cydn of the pulmonary infection group was lower than the control group level,while the Raw,Pmean,and Fres were higher than the control group level.The difference was statistically significant(P<0.05).The Cydn of patients with severe pulmonary infection was lower than that of patients with mild and moderate infection,while Raw,Pmean,and Fres were higher than those of patients with mild and moderate infection.The difference was statistically significant(P<0.05).The levels of Serum procalcitonin(PCT),tumor necrosis factor-α(TNF-α),and hypersensitive C-reactive protein(hs CRP)in patients with pulmonary infection were significantly higher than those of the control group,and the levels of serum procalcitonin(PCT),tumor necrosis factor-α(TNF-α)and hypersensitive C-reactive protein(hs CRP)in patients with severe pulmonary infection,were significantly higher than those of patients with mild to moderate infection,and the differences between the groups were statistically significant(P<0.05).Conclusion The pathogenic bacteria in patients with secondary lung infection after radiotherapy for lung cancer were mainly Gram negative bacteria,with a high resistance rate to common clinical antibiotics.The respiratory indicators of patients with secondary lung infection after radiotherapy for lung cancer deteriorate,and the PCT,TNF-α,and hs-CRP of inflammatory factors increases and changes with the severity of pulmonary infection,so it was necessary to conduct detection and prevention and control in clinical practice.