摘要
目的分析老年结直肠癌术后医院感染的病原菌分布及血清炎症因子和高迁移率族蛋白B1(HMGB1)/Toll样受体4(TLR4)信号通路表达.方法选择2019年3月—2021年3月于中国医科大学附属盛京医院行结直肠癌根治术治疗的356例老年患者作为研究对象,根据患者术后是否合并感染分为感染组80例和非感染组276例,分析患者术后医院感染的感染分布情况及病原学特点,分析两组患者HMGB1/TLR4信号通路炎症因子表达变化,分析患者血清炎性因子表达水平与预后的关系.结果80例感染患者感染分布主要以切口感染为主,占45.00%;80例患者共分离出85株病原菌,其中革兰阴性菌56株占65.88%,以大肠埃希菌为主,其对美罗培南及左氧氟沙星敏感性高,对头孢曲松、阿莫西林及头孢唑林耐药性高;革兰阴性菌26株占30.59%,以金黄色葡萄球菌为主,其对青霉素、左氧氟沙星及克林霉素药物耐药性高,对万古霉素敏感性高;真菌占3.53%;与非感染组比较,感染组血清降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-1β、IL-6、IL-8、IL-10和HMGB1、TLR4 mRNA相对表达量和蛋白表达水平均升高(P<0.05);356例老年患者术后死亡12例,病死率为3.37%,与存活组比较,死亡组血清PCT、TNF-α、IL-1β、IL-6、IL-8、IL-10和HMGB1、TLR4 mRNA相对表达量和蛋白表达水平均升高(P<0.05).结论老年结直肠癌腹腔镜下根治术后感染的病原菌以革兰阴性菌为主,伴随血清HMGB1、TLR4及炎性因子水平的变化,与患者预后密切相关.
OBJECTIVE To analyze the distribution of pathogens causing of postoperative nosocomial infection and the expression of serum inflammatory factors and high-mobility group protein B1(HMGB1)/Toll-like receptor 4(TLR4)signaling pathway in elderly patients with colorectal cancer.METHODS A total of 356 elderly patients who received postoperative infection after laparoscopic radical resection of colorectal cancer in Shengjing Hospital affiliated to China Medical University from Mar 2019 to Mar 2021 were recruited in the study.They were divided into the infected group(80 cases)and the non-infected group(276 cases)according to whether the infection oc-curred after surgery.The pathogen distribution and etiological characteristics of postoperative nosocomial infection in patients were analyzed.The expression changes of inflammatory factors in HMGB1/TLR4 signaling pathway between the two groups were analyzed.And the relationship between the expression level of serum inflammatory factors and prognosis was analyzed.RESULTS The constituent ratio of 80 patients with infection was mainly inci-sional infection(45.00%).A total of 85 strains of pathogenic bacteria were isolated from 80 patients,of which 56 strains were gram-negative,accounting for 65.88%,mainly Escherichia coli,which was highly drug-sensitive to meropenem and levofloxacin,and highly drug-resistant to ceftriaxone,amoxicillin and cefazolin.Twenty-six strains were gram-negative strains,accounted for 30.59%,mainly Staphylococcus aureus,which had high drug resistance to penicillin,levofloxacin and clindamycin,and high drug sensitivity to vancomycin.Fungi accounted for 3.53%.Compared with the non-infected group,mRNA relative expression levels and protein expression levels of PCT,TNF-α,IL-1β,IL-6,IL-8,IL-10,HMGB1 and TLR4 in the infected group were increased(P<0.05).Of the 356 elderly patients,12 died after operation,with a fatality rate of 3.37%.Compared with the survival group,the mRNA relative expression levels and protein expression levels of PCT,TNF-α,IL-1β,IL-6,IL-8,IL-10,HMGB1 and TLR4 in the death group were increased(P<0.05).CONCLUSION The main pathogens of infection after laparoscopic radical resection of elderly colorectal cancer are Gram-negative bacteria,which are closely related to the prognosis of patients with changes in serum HMGB1,TLR4 and inflammatory factors.
作者
张瑛
王园
库杰
程丹
ZHANG Ying;WANG Yuan;KU Jie;CHENG Dan(Shengjing I Hospital Affiliated to China Medical University,Shenyang,Liaoning 110000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第15期2347-2351,共5页
Chinese Journal of Nosocomiology
基金
辽宁省科学技术计划基金资助项目(201602869)。
关键词
老年结直肠癌
术后感染
病原菌
炎性因子
预后
高迁移率族蛋白B1
Toll样受体4
Senile colorectal cancer
Postoperative infection
Pathogen
Inflammatory factor
Prognosis
High-mobilitygroup protein B1
Toll-like receptor 4
