血清sTREM-1、肺功能指数与肺癌患者术后肺部感染的关系及其预测价值研究

目的:探讨血清髓样细胞触发受体-1(sTREM-1)、肺功能指数与肺癌患者术后肺部感染的关系及其预测价值。方法:回顾性分析2016年1月-2019年1月在我院进行手术治疗的115例肺癌患者的临床资料,根据患者术后72 h是否发生肺部感染将其分为感染组(n=28)及未感染组(n=87)。对比两组患者临床资料、术后6 h血清s TREM-1、降钙素原(PCT)水平及术前肺功能指数第一秒用力呼气量(FEV1)、呼气流量峰值(PEF)]变化,记录感染组患者痰细菌培养结果,采用Logistic分析肺癌患者术后感染的影响因素,并采用受试者工作特征(ROC)曲线分析s TREM-1、FEV1、PEF在肺癌术后感染的预测价值。结果:感染组术后入住ICU比例大于未感染组,感染组TNM分期为IV期的比例大于未感染组(P0.05),感染组术后6 h血清s TREM-1、PCT水平高于未感染组,术前FEV1、PEF水平低于未感染组(P0.05)。感染组痰培养结果提示G-菌为17例,占60.71%;G+菌10例,占35.71%;真菌1例,占3.57%。二元多因素Logistic分析提示术后6 h血清s TREM-1水平升高、术前FEV1下降及PEF下降、术后入住ICU为肺癌患者术后感染的独立影响因素。三者联合预测曲线下面积为0.850(95%CI:1.350～1.745,P=0.000),敏感度与特异性分别为91.3%与80.6%,优于s TREM-1、FEV1、PEF的单独预测效能。结论:s TREM-1水平升高,术前FEV1、PEF水平降低与肺癌患者术后肺部感染密切相关,对s TREM-1、FEV1、PEF三者联合分析对于预测肺癌患者术后肺部感染的发生具有较高的预测价值。

Study on the Relationship between Serum sTREM-1, Pulmonary Function Index and Pulmonary Infection after Lung Cancer Surgery and Their Predictive Value

ABSTRACT Objective: To explore the relationship between serum soluble triggering receptor expressed on myeloid cell-1 (sTREM-1), pulmonary function index and pulmonary infection in patients with lung cancer after operation and their predictive value. Methods: Clinical dataes of 115 patients with lung cancer treated surgically in our hospital from January 2016 to January 2019 were retrospectively analyzed. The patients were divided into infection group (n=28) and non-infection group (n=87) according to whether pulmonary infection occurred 72 hours after operation. The clinical data, serum levels of sTREM-1, procalcitonin (PCT), preoperative lung function index forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF)] at 6 hours after operation were compared between the two groups. Logistic analysis of risk factors of infection in patients with lung cancer after operation was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of sTREM-1, FEV1 and PEF in patients with lung cancer after operation. Results: The proportion of ICU admission in the infected group was higher than that in the non-infection group, and the proportion of TNM stage IV in the infected group was higher than that in the non-infection group (P<0.05). Serum levels of sTREM-1 and PCT were higher in the infection group than those in the non-infection group at 6 hours after operation, and the levels of preoperative FEV1 and PEF were lower than those in the non-infection group (P<0.05). The results of sputum culture in infection group showed that 17 cases were G-bacteria, accounting for 60.71%; 10 cases were G+bacteria, accounting for 35.71%; and 1 case was fungi, accounting for 3.57%. Bivariate multivariate logistic analysis showed that the increase of serum sTREM-1 level at 6 hours after operation, the decrease of preoperative FEV1 and PEF, and the admission to ICU after operation were independent influencing factors of infection in patients with lung cancer. The area under the combined prediction curve was 0.850 (95% CI: 1.350-1.745, P=0.000), and the sensitivity and specificity were 91.3% and 80.6% respectively, which were better than the single prediction efficiency of sTREM-1, FEV1 and PEF. Conclusion: The increase of sTREM-1 level and the decrease of preoperative FEV1 and PEF levels are closely related to pulmonary infection in patients with lung cancer after operation. The combined analysis of sTREM-1, FEV1 and PEF has a high predictive value in predicting the occurrence of pulmonary infection in patients with lung cancer after operation.