肺癌根治术后患者肺部感染危险因素及PLR、NLR与肺癌患者病理分型的相关性分析

Risk factors for pulmonary infection in postoperative lung cancer patients and correlation analysis between PLR,NLR and pathological classification of lung cancer patients

目的 探析肺癌根治术后并发肺部感染危险因素及PLR、NLR与肺癌患者病理分型的相关性。方法 选取95例于肺癌根治术后并发肺部感染患者及同期80例未并发肺部感染患者为研究对象。采集肺部感染患者痰液标本,进行菌种鉴定及药敏试验。计算血PLR、NLR水平,分析PLR、NLR与病理分型的相关性。对比感染组与对照组临床资料,通过单因素及多因素对比,分析肺癌根治术后并发肺部感染的危险因素。结果 共检出病原菌95株。其中革兰阴性菌共58株(61.05%),主要包括铜绿假单胞菌、肺炎克雷伯菌、流感嗜血杆菌。革兰阳性菌共28株(29.47%),主要包括金黄色葡萄球菌、肺炎链球菌、粪肠球菌。真菌共9株(9.47%),主要包括白色假丝酵母菌。革兰阴性菌对头孢他啶、环丙沙星、左氧氟沙星、庆大霉素、妥布霉素的耐药率高于50%,分别为60.34%、55.17%、58.62%、62.07%,对亚胺培南、美罗培南、阿米卡星的耐药率低于30%,分别为25.86%、29.31%、15.52%。革兰阳性菌对青霉素、红霉素、环丙沙星和复方磺胺甲恶唑的耐药率高于50%,分别为96.43%、78.57%、60.71%、71.43%,未产生对万古霉素、替考拉宁的耐药株。感染组与对照组患者肿瘤直径、高血压史、病程差异无统计学意义(P>0.05),年龄、吸烟史、糖尿病史、手术时间、术中出血量、慢性阻塞性肺部、机械通气时间差异有统计学意义(P<0.05)。年龄≥60岁、吸烟史、糖尿病史、手术时间≥150 min、术中出血量≥200 mL、机械通气时间≥6 h是肺癌根治术后并发肺部感染的独立危险因素(P<0.05)。TNM分期为T1~T2分组患者的PLR、NLR水平低于T3~T4分组患者,两组患者PLR水平差异无统计学意义(P>0.05),NLR水平差异有统计学意义(P<0.05)。腺癌患者PLR、NLR水平均高于鳞癌、小细胞癌患者,不同病例类型患者PLR水平、NLR水平差异无统计学意义(P>0.05)。有浆膜腔积液患者PLR、NLR水平高于无浆膜腔积液患者,两组患者PLR水平、NLR水平差异有统计学意义(P<0.05)。结论 肺癌根治术后并发肺部感染患者病原菌以革兰阴性菌为主,临床耐药率较高。肺部感染相关危险因素较多,患者年龄、吸烟史、糖尿病史、手术时间、术中出血量、机械通气时间均是导致肺部感染的独立危险因素。肺癌患者血PLR、NLR水平与病理分型具有一定相关性。

Objective To explore the risk factors for concurrent pulmonary infection after radical lung cancer surgery and the correlation between PLR,NLR and pathological classification of lung cancer patients.Methods 95 patients with postoperative pulmonary infection and 80 patients without postoperative pulmonary infection who underwent radical lung cancer surgery were selected as the study subjects.The sputum samples were collected from patients with pulmonary infections for bacterial identification and drug sensitivity tests.The levels of blood PLR and NLR were calculated to analyze the correlation between PLR,NLR and pathological classification.The clinical data between the infection group and the control group were compared to analyze the risk factors for postoperative pulmonary infection in lung cancer patients by single factor and multi factor comparisons.ResultsA total of 95 strains of pathogenic bacteria were detected.Among them,there were 58 strains(61.05%)of Gram negative bacteria,mainly including Pseudomonas aeruginosa,Klebsiella pneumoniae,and Haemophilus influenzae.There were 28 strains(29.47%)of Gram positive bacteria,mainly including Staphylococcus aureus,Streptococcus pneumoniae,and Enterococcus faecalis.There were a total of 9 fungi(9.47%),mainly including Candida albicans.The resistance rates of Gram negative bacteria to ceftazidime,ciprofloxacin,levofloxacin,gentamicin,and tobramycin were over 50%,60.34%,55.17%,58.62%,and 62.07%,respectively.The resistance rates to imipenem,meropenem,and amikacin were less than 30%,25.86%,29.31%,and 15.52%,respectively.The resistance rates of Gram positive bacteria to penicillin,erythromycin,ciprofloxacin,and compound sulfamethoxazole were higher than 50%,which were 96.43%,78.57%,60.71%,and 71.43%,respectively.No resistant strains to vancomycin or teicoplanin were produced.There was no significant difference in tumor diameter,hypertension history and course of disease between the infection group and the control group(P>O.05),but there was significant difference in age,smoking history,diabetes history,operation time,intraoperative blood loss,chronic obstructive.pulmonary disease,and mechanical ventilation time(P<0.05).Age≥60 years,smoking history,diabetes history,operation time≥150 min,intraoperative blood loss≥200 mL,and mechanical ventilation time≥6 h were independent risk factors for pulmonary infection after radical resection of lung cancer(P<o.o5).The PLR and NLR levels of patients in the T1-T2 group with TNM staging were lower than those in the T3-T4 group.The difference in PLR levels between the two groups was not statistically significant(P>0.05),while the difference in NLR levels was statistically significant(P<0.05).The PLR and NLR levels in adenocarcinoma patients were higher than those in squamous cell carcinoma and small cell carcinoma patients.There was no statistically significant difference in PLR and NLR levels among patients of different case types(P>0.05).The PLR and NLR levels in patients with serous effusion were higher than those in patients without serous effusion.The difference in PLR and NLR levels between the two groups of patients was statistically significant(P<o.05).Conclusion The pathogenic bacteria in patients with concurrent pulmonary infections after radical lung cancer surgery were mainly Gram negative bacteria,with a high clinical drug resistance rate.There were many risk factors related to lung infection.The patient's age,smoking history,diabetes history,operation time,intraoperative blood loss,and mechanical ventilation time were all independent risk factors leading to lung infection.The levels of blood PLR and NLR in lung cancer patients had a certain correlation with pathological classification.