Correlation between change of cellular immune level of gastric cancer patients before and after surgery and postoperative infections

目的 分析导致胃癌术后感染的危险因素,并探究细胞免疫水平变化与术后感染的关联性,为预测术后感染提供参考.方法 随机抽取2014年4月-2016年3月在医院行胃癌根治手术的30例患者(胃癌组)为研究对象,分析导致胃癌术后感染的危险因素,再动态监测胃癌组手术前后T淋巴细胞亚群水平和血清免疫球蛋白(IgM、IgG、IgA)水平,评价胃癌术后感染的检测指标及临床意义.结果 结果30例胃癌手术患者,9例患者术后发生感染,感染率30.0%.年龄、吸烟、手术范围、术前输血量及病理分期构成胃癌术后感染的独立危险因素,术前输血量(>3U)最为危险,胃癌组CD4+水平于术后6~8d时跌至低谷,之后复升至正常水平,与术前比较差异有统计学意义(P<0.05).结论 年龄、吸烟、手术范围、术前输血量及病理分期是诱发胃癌术后感染的独立危险因素,是临床防控的重点;从术后不同时间段CD4+水平波动趋势来看,CD4+下降或是引起术后感染的直接因素,强化临床免疫细胞水平检测对预测术后感染具有临床意义.OBJECTIVE To explore the risk factors for postoperative infections in gastric cancer patients and ob-serve the association between the change of cellular immune level and the postoperative infections so as to provide guidance for prediction of the postoperative infections .METHODS A total of 30 patients who underwent gastrecto-my in hospitals from Apr 2014 to Mar 2016 ( the gastric cancer group) were randomly extracted as the study ob-jects .The risk factors for the postoperative infections in the gastric cancer patients were analyzed ,the levels of T lymphocyte subsets and serum immunoglobulin (IgM ,IgG ,IgA ) of the gastric cancer group were dynamically monitored ,and the clinical value of the detection indexes for the postoperative infection was evaluated .RESULTS Of the 30 gastric cancer patients ,9 had the postoperative infections ,with the infection rate 30 .0% .The inde-pendent risk factors for the postoperative infections in the gastric cancer patients included the age ,smoking ,scope of surgery ,preoperative blood transfusion volume ,and pathological stage ,among which the preoperative blood transfusion volume (more than 3U) was the highest risk .The CD4 + level of the gastric cancer group dropped to the lowest level after the surgery for 6-8 days and then rose to the normal level ,and there was significant differ-ence in the CD4 + level before and after the surgery (P<0 .05) .CONCLUSION The independent risk factors for the postoperative infection in the gastric cancer patients include the age , smoking , scope of surgery , preoperative blood transfusion volume ,and pathological stage ,which are the key points for clinical control and prevention .In the view of fluctuation trend of the CD4 + level after the surgery for different time periods ,the reduced level of CD4 + may be the direct factor that induce the postoperative infection .It is of clinical significance for the prediction of the postoperative infection to intensify the detection of clinical cellular immune level .北京市卫生局首都卫生发展基金资助项目中国科学引文数据库(CSCD)61297-13002