肺癌化疗后肺部感染病原菌的分布及血清细胞角蛋白19片段抗原、高迁移率族蛋白B1及可溶性血红蛋白清道夫受体的诊断价值

郑钧麒; 刘相燕

doi:10.7619/jcmp.20241847

肺癌化疗后肺部感染病原菌的分布及血清细胞角蛋白19片段抗原、高迁移率族蛋白B1及可溶性血红蛋白清道夫受体的诊断价值

Distribution of pulmonary infection pathogens after lung cancer chemotherapy and diagnostic values of serum cytokeratin 19 fragment antigen, high mobility group box 1 protein and soluble hemoglobin scavenger receptor

摘要

摘要:
目的探讨肺癌化疗后肺部感染病原菌分布及血清细胞角蛋白19片段抗原(CYFRA21-1)、高迁移率族蛋白B1(HMGB1)、可溶性血红蛋白清道夫受体(sCD163)水平变化和诊断价值。
方法将2022年7月-2023年11月收治的83例肺癌化疗患者根据肺部感染情况分为未感染组(n=43)和感染组(n=40)。收集肺癌化疗患者痰液标本, 记录标本来源并进行菌种鉴定。比较2组血清CYFRA21-1、HMGB1、sCD163水平变化; 采用多因素Logistic回归模型分析肺癌化疗后肺部感染的影响因素; 分析血清CYFRA21-1、HMGB1、sCD163水平对肺癌化疗后肺部感染的诊断价值。
结果 80例肺癌化疗患者中, 发生肺部感染者40例; 病原菌检测出55株, 其中革兰阴性菌、革兰阳性菌分别为34、18株, 占比61.82%、32.73%, 真菌仅3株, 占比5.45%。感染组血清CYFRA21-1、HMGB1、sCD163水平均高于未感染组, 差异有统计学意义(P < 0.05)。年龄、肺部疾病史、CYFRA21-1、HMGB1、sCD163为肺癌化疗患者发生肺部感染的影响因素(P < 0.05)。血清CYFRA21-1、sCD163、HMGB1水平诊断肺癌化疗后肺部感染的曲线下面积依次为0.677、0.763、0.819(P < 0.05)。
结论肺癌化疗后, 肺部感染患者病原菌以革兰阴性菌为主, 血清CYFRA21-1、HMGB1、sCD163水平显著升高, 其可作为早期诊断和评估感染的生物学指标。

Abstract:
Objective To investigate the distribution of pathogens causing pulmonary infection after lung cancer chemotherapy and the changes and diagnostic value of serum cytokeratin 19 fragment antigen (CYFRA21-1), high mobility group box 1 protein (HMGB1), and soluble hemoglobin scavenger receptor (sCD163) levels.
Methods A total of 83 lung cancer patients with chemotherapy from July 2022 to November 2023 were divided into non-infected group (n=43) and infected group (n=40) based on their pulmonary infection status, sputum samples were collected from lung cancer chemotherapy patients, and the source of the samples was recorded for bacterial identification.The changes in serum CYFRA21-1, HMGB1 and sCD163 levels were compared between the two groups; a multivariate Logistic regression model was used to analyze the factors influencing pulmonary infection after lung cancer chemotherapy; the diagnostic values of serum CYFRA21-1, HMGB1 and sCD163 levels for pulmonary infection after lung cancer chemotherapy were analyzed.
Results Among the 83 patients with lung cancer chemotherapy, 40 cases had pulmonary infections; a total of 55 strains of pathogens were detected, including 34 Gram-negative bacteria and 18 Gram-positive bacteria, accounting for 61.82% and 32.73% respectively, while only 3 strains of fungi were detected, accounting for 5.45%.Serum levels of CYFRA21-1, HMGB1 and sCD163 in the infected group were significantly higher than those in the non-infected group (P < 0.05).Age, history of lung diseases, CYFRA21-1, HMGB1 and sCD163 were factors influencing pulmonary infection in patients with lung cancer chemotherapy (P < 0.05).The areas under the curve for the diagnostic value of serum CYFRA21-1, sCD163 and HMGB1 levels for pulmonary infection after lung cancer chemotherapy were 0.677, 0.763 and 0.819, respectively (P < 0.05).
Conclusion The main pathogens causing pulmonary infection after lung cancer chemotherapy are Gram-negative bacteria, and the serum levels of CYFRA21-1, HMGB1 and sCD163 increase significantly, which can be used as biological indicators for early diagnosis and assessment of infection.

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