甲泼尼龙对行新辅助化疗联合免疫治疗局部晚期食管癌患者术后肺部感染的预防效果

Efficacy of methylprednisolone in preventing postoperative pulmonary infections in locally advanced esophageal cancer patients undergoing neoadjuvant chemotherapy combined with immunotherapy

目的探讨甲泼尼龙对行辅助化疗联合免疫治疗的局部晚期食管癌患者术后肺部感染的预防效果。方法选择2022年1月至2023年12月新乡医学院第一附属医院收治的89例局部晚期食管癌患者为研究对象,所有患者行胸腹腔镜联合食管癌根治术。采用随机数字表法将患者分为观察组(n=45)和对照组(n=44),观察组有1例术中中转开胸、2例胸腔广泛粘连、1例术前合并上呼吸道感染被排除,对照组有1例胸腔广泛粘连、1例术前合并上呼吸道感染被排除,本研究共纳入83例研究对象,观察组和对照组分别为41例和42例。术前2组患者均给予白蛋白结合型紫杉醇+奈达铂联合卡瑞利珠单抗新辅助治疗方案2周期。术后对照组患者接受抗感染常规治疗,观察组患者于术后第1天至第3天,每日静脉滴注甲泼尼龙1 mg·kg^(-1)。比较2组患者术后炎症指标、术后肺部感染发生率、吻合口瘘发生率、术后住院时间、住院总花费情况。结果术前,2组患者白细胞计数、中性粒细胞比例、降钙素原(PCT)、超敏C反应蛋白(hs-CRP)和白细胞介素-6(IL-6)水平比较差异无统计学意义(P>0.05)。术后1、4 d,观察组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著高于术前(P<0.05),术后4 d患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著低于术后1 d(P<0.05)。术后1、4 d,对照组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著高于术前(P<0.05),术后4 d白细胞计数、中性粒细胞比例和hs-CRP水平显著低于术后1 d(P<0.05);术后4 d与术后1 d患者PCT和IL-6水平比较差异无统计学意义(P>0.05)。术后1 d,观察组与对照组患者白细胞计数、中性粒细胞比例、PCT、hs-CRP和IL-6水平比较差异无统计学意义(P>0.05);术后4 d,观察组患者白细胞、中性粒细胞比例、PCT、hs-CRP和IL-6水平显著低于对照组(P<0.05)。对照组与观察组患者肺部感染发生率分别为30.9%(13/42)、12.2%(5/41);观察组患者肺部感染发生率显著低于对照组(χ^(2)=4.298,P<0.05)。观察组患者吻合口瘘发生率为9.76%(4/42),对照组吻合口瘘发生率为21.43%(9/42);2组比较差异无统计学意义(χ^(2)=2.140,P>0.05)。对照组患者术后住院时间显著长于观察组(P<0.05);对照组患者住院总费用显著高于观察组(P<0.05)。结论甲泼尼龙可有效降低术前行新辅助化疗联合免疫治疗食管癌患者术后炎症指标水平及肺部感染发生率,且未增加吻合口瘘发生率,安全性较高。

Objective To investigate the efficacy of methylprednisolone in preventing postoperative pulmonary infections in locally advanced esophageal cancer patients undergoing neoadjuvant chemotherapy combined with immunotherapy.Methods A total of 89 patients with locally advanced esophageal cancer treated at the First Affiliated Hospital of Xinxiang Medical University from January 2022 to December 2023 were selected as the research subjects.All patients underwent thoracolaparoscopic radical esophagectomy for esophageal cancer.The patients were randomly divided into an observation group(n=45)and a control group(n=44)using a random number table method.In the observation group,one patient with intraoperative thoracotomy,two patients with extensive pleural adhesion,and one patient with preoperative upper respiratory tract infection were excluded.In the control group,one patient with extensive pleural adhesion and one patient with preoperative upper respiratory tract infection were excluded.As a result,a total of 83 patients were included in the study,with 41 in the observation group and 42 in the control group.Preoperatively,a neoadjuvant treatment regimen of paclitaxel(albumin-bound)+nedaplatin in combination with camrelizumab was given to patients in both groups for 2 cycles.Patients in the control group received conventional anti-infection treatment after surgery,while patients in the observation group were intravenously injected with methylprednisolone at a dose of 1 mg·kg^(-1) daily from the first to the third day after surgery.Postoperative inflammatory markers,incidence of postoperative pulmonary infections,incidence of anastomotic fistula,postoperative hospital stay,and total hospitalization costs were compared between the two groups.Results There were no statistically significant differences in leukocyte count,neutrophil ratio,procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),and interleukin-6(IL-6)levels of patients between the two groups before treatment(P>0.05).On day 1 and 4 after treatment,patients in the observation group had significantly higher leukocyte count,neutrophil ratio,PCT,hs-CRP,and IL-6 levels compared to those before treatment(P<0.05).On postoperative day 4,the leukocyte count,neutrophil ratio,PCT,hs-CRP,and IL-6 levels were significantly lower than those on day 1 postoperatively(P<0.05).On postoperative days 1 and 4,the leukocyte count,neutrophil ratio,PCT,hs-CRP and IL-6 levels of patients in the control group were significantly higher than those in the preoperative period(P<0.05),and the leukocyte count,neutrophil ratio and hs-CRP level were significantly lower on day 4 after surgery than on day 1 after surgery(P<0.05);the differe-nces in PCT and IL-6 level of patients between day 4 after surgery and day 1 after surgery were not statistically significant(P>0.05).On postoperative day 1,there were no statistically significant differences in leukocyte count,neutrophil ratio,PCT,hs-CRP,and IL-6 levels between patients in the observation group and the control group(P>0.05).On postoperative day 4,the leukocyte count,neutrophil ratio,PCT,hs-CRP,and IL-6 levels of patients in the observation group were significantly lower than those in the control group(P<0.05).The incidence of pulmonary infections in patients in the control group and the observation group was 30.9%(13/42)and 12.2%(5/41),respectively;the incidence of pulmonary infections in patients in the observation group was significantly lower than that in the control group(χ^(2)=4.298,P<0.05).The incidence of anastomotic fistula in patients in the observation group and the control group was 9.76%(4/42)and 21.43%(9/42),respectively;there was no statistically significant difference between the two groups(χ^(2)=2.140,P>0.05).The postoperative hospital stay was significantly longer in the control group than in the observation group(P<0.05),and the total hospitalization costs were significantly higher in the control group than in the observation group(P<0.05).Conclusion Methylprednisolone can effectively reduce the levels of inflammatory markers and the incidence of postoperative pulmonary infections in esophageal cancer patients undergoing neoadjuvant chemotherapy combined with immunotherapy before surgery.It is a highly safe treatment therapy without increasing the incidence of anastomotic fistula.