CD64指数联合IL-1β、TLR4在诊断结直肠癌患者术后感染中的临床价值

Value of CD64 index combined with IL-1βand TLR4 in the diagnosis of postoperative infection of colorectal cancer

目的探讨CD64指数联合血清白细胞介素-1β(IL-1β)、Toll样受体4(TLR4)在诊断结直肠癌患者术后切口感染中的临床应用价值。方法以2020年6月至2022年6月收治入院的113例行结直肠癌根治术患者作为研究对象,根据其术后是否发生切口感染,分为感染组与非感染组。分别于术前、术后3 d及术后5 d检测外周血CD64指数及血清IL-1β、TLR4水平,绘制ROC曲线并分析各指标单独及联合应用时诊断结直肠癌术后切口感染的临床应用价值,以及三者与患者切口感染严重程度之间的关系。结果术后3 d及术后5 d,感染组患者CD64指数以及血清IL-1β、TLR4水平均高于非感染组;术后3 d,感染组患者CD64指数、血清IL-1β及TLR4水平均较术前明显上升;术后5 d,感染组各指标均较术后3 d有所下降,但依旧高于术前水平,差异均具有统计学意义(P<0.05)。非感染组患者术前、术后3 d以及术后5 d CD64指数、IL-1β、TLR4水平差异均无统计学意义(P>0.05)。以术后3 d作为预测结直肠癌术后感染的时间点绘制各指标的ROC曲线,结果发现CD64指数、血清IL-1β、TLR4单独及三者联合应用预测结直肠癌术后感染的AUC^(ROC)分别为0.937、0.901、0.790及0.997(95%CI:0.992~1.000),各指标单独应用能较好地预测结直肠癌术后感染,三者联合应用的预测效能最高。结论外周血CD64指数、血清IL-1β、TLR4在预测结直肠癌术后切口感染中具有良好效能,三者联合应用的预测效能最高,可作为临床筛查术后感染的早期预测指标。

Objective To explore the value of CD64 index combined with serum interleukin-1β(IL-1β)and Toll-like receptor 4(TLR4)levels in the diagnosis of postoperative incision infection in patients undergoing colorectal cancer surgery.Methods A total of 113 patients undergoing radical resection of colorectal cancer in our hospital from June 2020 to June 2022 were enrolled as the study subjects.They were divided into infected group and non-infected group according to whether incision infection occurred after surgery.Peripheral blood CD64 index and the levels of serum IL-1βand TLR4 were detected before surgery and 3 and 5 days after surgery.The receiver operating characteristic(ROC)curve was drawn to analyze the value of each indicator and their combination in the diagnosis of postoperative incision infection of colorectal cancer and the relationship between three indicators and severity of incision infection.Results On the 3 rd and 5 th days after surgery,the CD64 index and levels of serum IL-1βand TLR4 in the infected group were higher than those in the non-infected group,and the three indicators in the infected group on the 3 rd day after surgery were significantly increased compared with those before surgery.The three indicators in the infected group on the 5 th day after surgery were decreased compared with those on the 3 rd day after surgery,but they were still higher than those before surgery,with statistical differences(P<0.05).There were no significant differences in CD64 index and serum IL-1βand TLR4 levels in the non-infected group before surgery and on the 3 rd and 5 th days after surgery(P>0.05).The ROC curve drawn with each indicator on the 3 rd day after surgery showed that the areas under the ROC curve(AUC^(ROC))of CD64 index,serum IL-1βand TLR4,and their combination in predicting the postoperative infection of colorectal cancer were 0.937,0.901,0.790,and 0.997(95%CI:0.992-1.000),respectively,indicating that each indicator alone could better predict the postoperative infection of colorectal cancer,and the combination of the three indicators might have the best predictive efficiency.Conclusion Peripheral blood CD64 index and serum IL-1βand TLR4 levels have good efficiency in predicting the postoperative incision infection of colorectal cancer,and their combined application has the highest predictive efficiency,which can be used as early predictors for the clinical screening of postoperative infection.