原发性肺癌术后并发肺部感染患者外周血血管紧张素转化酶2、高迁移率族蛋白B1、白细胞介素33水平变化及临床意义探究

Clinical significance of changes in peripheral blood angiotensin-converting enzyme 2,high mobility group protein B1 and interleukin-33 levels in patients with primary lung cancer complicated by pulmonary infection after surgery

目的探讨原发性肺癌术后并发肺部感染患者外周血血管紧张素转化酶2(ACE2)、高迁移率族蛋白B1(HMGB1)、白细胞介素33(IL-33)水平变化及临床意义。方法回顾性选取2018年8月至2021年2月在隆昌市人民医院诊治的92例原发性肺癌患者,均行肺癌根治术,根据患者术后是否并发肺部感染分为肺部感染组(27例)和非肺部感染组(65例)。比较两组临床资料、手术前后外周血ACE2、HMGB1及IL-33水平,采用Lasso回归、Logistic回归分析原发性肺癌患者术后并发肺部感染的危险因素;以受试者工作特征(ROC)曲线中术后外周血ACE2、HMGB1及IL-33截断值为界,分为高水平组与低水平组,绘制Kaplan-Meier生存曲线,比较外周血ACE2、HMGB1及IL-33高水平患者与低水平患者生存率的差异。结果肺部感染组慢性阻塞性肺疾病发生率高于非肺部感染组[40.74%(11/27)比15.38%(10/65)],差异有统计学意义(χ^(2)=6.96,P<0.05)。肺部感染组术后外周血ACE2、HMGB1及IL-33水平高于非肺部感染组[(36.87±9.87)mg/L比(25.94±8.69)mg/L、(24.49±8.14)μg/L比(16.74±5.07)μg/L、(51.48±8.25)ng/L比(39.88±6.85)ng/L],差异有统计学意义(P<0.05)。Lasso回归和Logistic回归分析结果表明,慢性阻塞性肺疾病、术后外周血ACE2、HMGB1及IL-33水平均为原发性肺癌患者术后并发肺部感染的独立危险因素(P<0.05)。ROC曲线分析结果显示,术后外周血ACE2、HMGB1及IL-33水平预测原发性肺癌患者术后并发肺部感染的曲线下面积(AUC)分别为0.705、0.821、0.768,联合预测的AUC为0.935。术后外周血ACE2、HMGB1及IL-3高水平患者死亡风险分别是低水平患者的7.500、4.874、2.857倍。结论外周血ACE2、HMGB1、IL-3水平是评估原发性肺癌患者术后发生肺部感染的重要指标。

Objective To investigate the changes in peripheral blood angiotensin-converting enzyme 2(ACE2),high mobility group protein B1(HMGB1)and interleukin 33(IL-33)levels and their clinical significance in patients with primary lung cancer complicated by lung infection after surgery.Methods The clinical data of 92 primary lung cancer patients treated at Longchang People′s Hospital from August 2018 to February 2021 were retrospectively collected,they were underwent radical lung cancer surgery,and were divided into the pulmonary infection group(27 cases)and the non-pulmonary infection group(65 cases)according to whether the patients had postoperative complications of pulmonary infection.The clinical data,peripheral blood ACE2,HMGB1 and IL-33 levels before and after surgery between the two groups were compared.The risk factors associated with postoperative pulmonary infection were analyzed by Lasso regression and Logistic regression.The predictive value of pulmonary infection was analyzed by receiver operating characteristic(ROC)curve.The cut-off values of peripheral blood ACE2,HMGB1 and IL-33 in the ROC curve were used as the boundary to divide the high level group and low level group,and the Kaplan-Meier survival curve was drawn to compare the survival rates of patients with high levels and low levels of peripheral blood ACE2,HMGB1 and IL-33.Results The incidence of chronic obstructive pulmonary disease in the pulmonary infection group was higher than that in the non-pulmonary infection group:40.74%(11/27)vs.15.38%(10/65),there was statistical difference(χ^(2)=6.96,P<0.05).The levels of postoperative peripheral blood ACE2,HMGB1 and IL-33 in the pulmonary infection group were higher than those in the non-pulmonary infection group:(36.87±9.87)mg/L vs.(25.94±8.69)mg/L,(24.49±8.14)μg/L vs.(16.74±5.07)μg/L,(51.48±8.25)ng/L vs.(39.88±6.85)ng/L,there were statistical differences(P<0.05).The results of Lasso regression and Logistic regression showed that the chronic obstructive pulmonary disease,postoperative peripheral blood ACE2,HMGB1 and IL-33 levels were independent risk factors for postoperative complications of pulmonary infection in patients with primary lung cancer(P<0.05).The results of ROC curve showed that the area under the curve(AUC)values for postoperative peripheral blood ACE2,HMGB1 and IL-33 levels predicting postoperative complications of lung infection were 0.705,0.821 and 0.768,respectively,and the AUC for the combination was 0.935.The risk of death in patients with high levels of postoperative peripheral blood ACE2,HMGB1 and IL-3 were 7.500,4.874 and 2.857 times than the patients with low levels.Conclusions Postoperative peripheral blood ACE2,HMGB1 and IL-3 levels in patients with primary lung cancer are important factors for pulmonary infection,which can be used for early prediction and evaluation after operation.