摘要
目的探讨肺癌调强放疗(IMRT)患者放射性肺炎合并肺部感染影响因素及血清辅助性T细胞(Th)1/Th2细胞水平。方法回顾性分析2016年1月-2021年1月天津市第五中心医院242例肺癌IMRT放射性肺炎患者的临床资料,根据是否合并肺部感染分为感染组38例和非感染组204例。对感染组患者病原菌分布情况进行分析,分析影响肺癌IMRT放射性肺炎患者合并肺部感染的因素,比较两组血清白细胞介素(IL)-2、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)/IL-4水平。结果38例合并肺部感染患者共分离出病原菌45株,其中2株真菌(4.44%)、17株革兰阳性菌(37.78%)、26株革兰阴性菌(57.78%);Logistic回归分析,结果显示,年龄≥60岁、肺部疾病、放射剂量≥60 Gy均为影响肺癌IMRT放射性肺炎合并肺部感染的危险因素(P<0.05);感染组血清IL-2、IFN-γ/IL-4低于非感染组,TNF-α高于非感染组(P<0.05)。结论肺癌IMRT放射性肺炎合并肺部感染患者病原菌分布以革兰阴性菌为主,年龄、肺部疾病、放射剂量均为肺癌IMRT放射性肺炎合并肺部感染的危险因素,临床可检测血清Th1/Th2细胞水平,指导临床进行防治。
OBJECTIVE To explore the influencing factors for pulmonary infection in radiation pneumonia patients undergoing intensity modulated radiation therapy(IMRT)and analyze the level of serum helper T cells(Th)1/Th2.METHODS Totally 242 radiation pneumonia patients who underwent IMRI for lung cancer in Tianjin Fifth Central Hospital from Jan 2016 to Jan 2021 were enrolled in the study and divided into the infection group with 38 cases and the no infection group with 204 cases according to the status of pulmonary infection.The clinical data of the patients were retrospectively analyzed.The distribution of pathogens isolated from the patients of the infection group was observed,the influencing factors for the pulmonary infection in the radiation pneumonia patients were analyzed.The levels of serum interleukin(IL)-2,tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ)/IL-4 were observed and compared between the two groups.RESULTS Totally 45 strains of pathogens were isolated from 38 patients complicated with pulmonary infection,2(4.44%)of which were fungi,17(37.78%)were gram-positive bacteria,and 26(57.78%)were gram-negative bacteria.The result of logistic regression analysis showed that the no less than 60 years of age,pulmonary disease,radiation dose no less than 60 Gy were the risk factors for the radiation pneumonia complicated with pulmonary infection in the lung cancer patients undergoing IMRT(P<0.05).The levels of serum IL-2 and IFN-γ/IL-4 of the infection group were lower than those of the no infection group,while the TNF-αlevel of the infection group was higher than that of the no infection group(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens isolated from the radiation pneumonia patients complicated with pulmonary infection undergoing IMRT.The age,pulmonary disease and radiation dose are the risk factors for the pulmonary infection in the radiation pneumonia patients undergoing IMRT for lung cancer.The clinical detection of serum Th1/Th2 may facilitate the clinical prevention and treatment.
作者
丁国伟
姜明哲
李国忠
梁春梅
王英
DING Guo-wei;JIANG Ming-zhe;LI Guo-zhong;LIANG Chun-mei;WANG Ying(Tianjin Fifth Central Hospital,Tianjin 300450,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第21期3234-3238,共5页
Chinese Journal of Nosocomiology
基金
天津市卫生局科技基金资助项目(2020KZ018)。
关键词
肺癌
调强放疗
放射性肺炎
肺部感染
辅助性T细胞
Lung cancer
Intensity modulated radiation therapy
Radiation pneumonia
Pulmonary infection
Helper T cell
