目的: 探讨肺癌合并慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者化疗后下呼吸道感染病原菌分布及血清降钙素原（procalcitonin,PCT）、白细胞介素（interleukin,IL）-6、C反应蛋白（C-reactive protein,CRP）水平与病情严重程度和预后的关系。方法: 选取2022年9月—2024年3月就诊的116例肺癌合并COPD患者化疗后下呼吸道感染者的临床资料进行研究,另选同期50例肺癌合并COPD患者化疗后下呼吸道未感染者作为非感染组,根据急性生理与慢性健康（acute physiology and chronic health evaluation II,APACHE Ⅱ） 评分将感染患者分为轻中度组和重度组。观察各组患者的PCT、IL-6、CRP水平变化。对感染组进行了3个月的随访,根据预后情况分为死亡组和存活组。采用ROC分析方法,评估血清PCT、IL-6、CRP对肺癌合并COPD患者化疗后下呼吸道感染预后的预测效能。结果: 肺癌合并COPD患者化疗后下呼吸道感染的病原菌以革兰氏阴性菌为主（55.86%）,其次为革兰氏阳性菌（38.62%）和真菌（5.52%）。感染组PCT、IL-6、CRP水平高于非感染组（P<0.05）;重度感染组患者PCT、IL-6、CRP水平均高于轻中度感染组（P<0.05）;感染组患者中,死亡组患者的血清PCT、IL-6、CRP水平均高于存活组（P<0.05）。Logistic回归分析显示,PCT>5.133 ng/mL、IL-6>52.630 pg/mL、CRP>87.949 mg/L是患者预后不良的危险因素（P<0.05）。ROC曲线分析显示,血清PCT、IL-6、CRP水平联合用于评估肺癌合并COPD患者化疗后下呼吸道感染者预后敏感度和特异度均较高（80.00%、83.33%）。结论: 肺癌合并COPD患者化疗后下呼吸道感染的病原菌分布复杂多样,革兰氏阴性菌是主要致病菌。血清PCT、IL-6、CRP水平可作为评估病情严重程度和预后的重要指标。
Abstract
Objective To explore distribution of lower respiratory tract infection (LRTI) pathogens and the relationship between serum procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP) and disease severity, prognosis of patients with lung cancer and chronic obstructive pulmonary disease (COPD) after chemotherapy. Methods The clinical data were collected from 116 patients with lung cancer, COPD and LRTI after chemotherapy (infection group) between September 2022 and March 2024, while 50 patients with lung cancer, COPD and non-LRTI during the same period were enrolled as non-infection group. According to scores of acute physiology and chronic health evaluation II (APACHE II), patients in infection group were divided into mild-moderate group and severe group. The changes of PCT, IL-6 and CRP in different groups were observed. All patients in infection group were followed up for 3 months, and they were divided into death group and survival group according to prognosis. The predictive efficiency of serum PCT, IL-6 and CRP for prognosis of LRTI was evaluated by receiver operating characteristic (ROC) curves. Results The main pathogens of LRTI were Gram-negative bacteria (55.86%), Gram-positive bacteria (38.62%) and fungi (5.52%). The levels of PCT, IL-6 and CRP in infection group were higher than those in non-infection group (P<0.05). The levels of PCT, IL-6 and CRP in severe infection group were higher than those in mild-moderate infection group (P<0.05). The levels of serum PCT, IL-6 and CRP in death group were higher than those in survival group (P<0.05). Logistic regression analysis showed that PCT>5.133ng/mL, IL-6>52.630 pg/mL and CRP>87.949 mg/L were risk factors of poor prognosis (P<0.05). ROC curves analysis showed that sensitivity and specificity of serum PCT combined with IL-6 and CRP for evaluating prognosis of LRTI were higher (80.00%, 83.33%). Conclusion The distribution of LRTI pathogens is complex and diverse in patients with lung cancer and COPD after chemotherapy, and Gram-negative bacteria are the main pathogens. Serum PCT, IL-6 and CRP can be applied as important indexes to evaluate disease severity and prognosis.
关键词
肺癌 /
慢性阻塞性肺疾病 /
下呼吸道感染 /
病原菌分布 /
病情严重程度
Key words
lung cancer /
chronic obstructive pulmonary disease /
lower respiratory tract infection /
pathogen distribution /
disease severity
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基金
淮安市科学技术局市级科技计划“NRP1抑制剂联合吉非替尼通过调节PI3K/Akt信号通路对EGFR-TKI耐药非小细胞肺癌细胞的影响”（HAB202316）
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