血清Gas6、CXCL10对非小细胞肺癌术后肺部细菌感染的诊断价值

Diagnostic value of serum Gas6 and CXCL10 for postoperative pulmonary bacterial infection in non-small cell lung cancer patients

目的探究血清生长停滞特异性蛋白6(Gas6)、CXC趋化因子配体10(CXCL10)对非小细胞肺癌(NSCLC)术后肺部细菌感染的诊断价值。方法选取2021年1月至2023年3月在该院进行手术治疗的NSCLC患者107例,根据术后是否发生肺部细菌感染分为感染组(35例)和未感染组(72例)。收集NSCLC患者临床资料,酶联免疫吸附试验检测血清Gas6、CXCL10水平,对NSCLC术后发生肺部细菌感染患者进行病原菌鉴定。采用多因素Logistic回归分析NSCLC患者术后肺部细菌感染的影响因素,采用受试者工作特征(ROC)曲线分析血清Gas6、CXCL10对NSCLC患者术后肺部细菌感染的预测价值,并计算Kappa值评价血清Gas6、CXCL10与金标准的一致性。结果107例NSCLC患者术后肺部细菌感染35例,培养分离出细菌52株,其中革兰阳性菌29株,革兰阴性菌23株,肺炎链球菌占比最高为30.77%。感染组年龄≥60岁、手术时间≥3 h、住院时间≥30 d、有侵入性操作比例及血清Gas6、CXCL10水平显著高于未感染组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,有侵入性操作、Gas6、CXCL10是NSCLC患者术后肺部细菌感染的影响因素(P<0.05)。ROC曲线分析显示,血清Gas6、CXCL10及联合预测NSCLC患者术后肺部细菌感染的曲线下面积(AUC)分别为0.720、0.863、0.938,其中联合预测AUC显著高于二者单独预测AUC(Z_(联合-Gas6)=3.392,Z联合-CXCL10=1.432,P<0.05);血清Gas6、CXCL10及联合检查结果与金标准诊断结果一致性的Kappa值分别为0.471、0.713、0.730(P<0.05)。结论Gas6、CXCL10水平在NSCLC术后肺部细菌感染患者血清中升高,对术后肺部细菌感染的发生具有一定的预测价值。

Objective To investigate the diagnostic value of serum growth arrest specific protein 6(Gas6)and CXC chemokine ligand 10(CXCL10)in postoperative pulmonary bacterial infection in non-small cell lung cancer(NSCLC).Methods A total of 107 NSCLC patients who underwent surgery in the hospital from January 2021 to March 2023 were collected and grouped into the infection group(35 cases)and the non-infection group(72 cases)based on whether pulmonary bacterial infection occurred after surgery.Clinical data of NSCLC patients were collected,enzyme linked immunosorbent assay was applied to detect serum levels of Gas6 and CXCL10,pathogen identification was performed among patients with pulmonary bacterial infection after NSCLC surgery.Multivariate Logistic regression was applied to analyze the influencing factors of postoperative pulmonary bacterial infection in NSCLC patients.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of serum Gas6 and CXCL10 for postoperative pulmonary bacterial infection in NSCLC patients,Kappa value was calculated to evaluate the consistency of serum Gas6 and CXCL10 with the gold standard.Results Among the 107 NSCLC patients,35 cases had postoperative pulmonary bacterial infections,and 52 bacterial strains were isolated after culture,and among them,29 were Gram positive,23 were Gram negative.Streptococcus pneumoniae had the highest proportion at 30.77%.The proportions of patients with age≥60 years old,surgical time≥3 hours,hospital stay≥30 days,invasive procedures,and the serum levels of Gas6 and CXCL10 in the infection group were obviously higher than those in the non-infection group,and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that invasive procedures,Gas6 and CXCL10 were the influencing factors for postoperative pulmonary bacterial infection in NSCLC patients(P<0.05).The ROC curve showed that the area under the curve(AUC)of serum Gas6,CXCL10 and combined prediction of postoperative pulmonary bacterial infection in NSCLC patients was 0.720,0.863,and 0.938,respectively,and the AUC of combined prediction was obviously higher than that of two alone prediction(Z_(combination-Gas6)=3.392,Z combination-CXCL10=1.432,P<0.05).The Kappa values of consistency between serum Gas6,CXCL10 and combined examination results and gold standard diagnosis results were 0.471,0.713 and 0.730,respectively(P<0.05).Conclusion The levels of Gas6 and CXCL10 increase in the serum of patients with pulmonary bacterial infection after NSCLC surgery,which has certain predictive value for the occurrence of postoperative pulmonary bacterial infection.