腹腔镜直肠癌根治术后外周血炎症指标变化趋势对腹腔感染性并发症的预测价值

邱权威; 葛思堂; 左芦根; 刘牧林

doi:10.16766/j.cnki.issn.1674-4152.002976

腹腔镜直肠癌根治术后外周血炎症指标变化趋势对腹腔感染性并发症的预测价值

doi: 10.16766/j.cnki.issn.1674-4152.002976

邱权威^{1, 2},
葛思堂^{1, 2},
左芦根^{1, 2},
刘牧林^{1, 2, ,}

1.
蚌埠医学院第一附属医院胃肠外科，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院消化道肿瘤研究中心

基金项目:

安徽省自然科学基金面上项目 2108085MH291

安徽省教育厅自然科学重大项目 KJ2021ZD0092

蚌埠医学院科研创新团队立项项目 BYKC201909

详细信息

通讯作者:
刘牧林，E-mail: liumulin66@aliyun.com

中图分类号: R735.37 R730.6
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- 被引次数: 0
出版历程
- 收稿日期: 2022-09-21

Predictive values of trends in peripheral blood inflammatory indexes for infectious abdominal complications after laparoscopic radical rectal cancer surgery

QIU Quanwei^{1, 2},
GE Sitang^{1, 2},
ZUO Lugen^{1, 2},
LIU Mulin^{1, 2
, ,}

1.
Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的分析外周血炎症指标的变化趋势，探讨其对预测腹腔镜直肠癌术后患者腹腔感染性并发症(IASCs)的发生是否具有预测诊断价值。方法选取2020年6月—2022年4月在蚌埠医学院第一附属医院行腹腔镜直肠癌根治性手术的患者，根据术后是否发生腹腔感染性并发症(IASCs)将其分为IASC组和非IASC组。共纳入患者156例，其中19例(12.18%)术后并发IASC。分析2组患者术后外周血肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和白细胞计数(WBC)的变化趋势，以及对术后腹腔感染性并发症的预测诊断价值。结果 2组患者术后1 d外周血WBC、CRP和TNF-α比较差异无统计学意义(P＞0.05)。术后3 d，IASC组患者外周血TNF-α及CRP均显著高于非IASC组。受试者工作曲线(ROC)分析显示，术后3 d外周血TNF-α和CRP水平预测术后IASCs发生的阴性预测值均高于80%，但阳性预测值均低于50%。取患者术后3 d外周血TNF-α、CRP和术后1 d水平的比值，纳入ROC分析并发现：ΔTNF-α预测术后IASCs发生的阳性及阴性预测值均优于ΔCRP。结论腹腔镜直肠癌根治术后外周血TNF-α的变化趋势对IASCs具有一定的预测诊断价值。
- 腹腔镜直肠癌根治术 /
- 腹腔感染性并发症 /
- 肿瘤坏死因子α /
- C-反应蛋白 /
- 预测
Abstract: Objective To analyze the changes in peripheral blood inflammatory indicators and explore the predictive diagnostic values in predicting the occurrence of Intra-Abdominal Septic Complications (IASCs)in patients after laparoscopic rectal cancer surgery. Methods Patients who underwent laparoscopic radical surgery for rectal cancer in the First Affiliated Hospital of Bengbu Medical College from June 2020 to April 2022 were included as subjects in the study and were divided into IASC group and non-IASC group according to whether IASCs occurred. One hundred and fifty-six patients were included in this study, of which 19 cases (12.18%) were happened. The trend and predictive value of postoperative peripheral TNF-α, CRP and WBC for postoperative IASCs were analyzed in both groups. Results There was no significant difference between two groups in the levels of WBC, CRP and TNF-α in peripheral blood 1-day after surgery (P>0.05). The levels of TNF-α and CRP in peripheral blood 3-day after surgery were higher in IASC group than those in non-IASC group. ROC curve shows that the levels of TNF-α and CRP in peripheral blood 3 days after surgery predicted the occurrence of postoperative IASCs with negative predictive values above 80%, however, the positive predictive values were below 50%. Take ΔTNF-α and ΔCRP into ROC analysis. The results showed that the positive and negative predictive values of ΔTNF-α were superior to those of ΔCRP. Conclusion The changing trend of TNF-α in peripheral blood showed certain predictive and diagnostic values for IASCs after laparoscopic radical rectal cancer surgery.
- Laparoscopic radical resection of colorectal cancer /
- Intra-abdominal septic complications /
- Tumor necrosis factor α /
- C-reactive protein /
- Prognosis
利益冲突 无

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图 1 术后3 d外周血TNF-α及CRP水平对术后IASCs的预测价值

Figure 1. The predictive value of TNF-α and CRP in peripheral blood at 3-day after surgery for postoperative IASCs

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图 2 ΔTNF-α及ΔCRP对术后IASCs预测价值

Figure 2. The predictive value of ΔTNF-α and ΔCRP for postoperative IASCs

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表 1 2组直肠癌患者临床资料及术前实验室指标的比较

Table 1. Comparison of clinical data and preoperative laboratory indices of rectal cancer patients in 2 groups

项目	IASC组(n=19)	非IASC组(n=137)	统计量	P值
性别(例)			0.007^a	0.935
男性	13	95
女性	6	42
年龄(x±s, 岁)	59.95±9.81	59.61±9.95	0.137^b	0.891
吸烟史			0.086^a	0.769
有	9	60
无	10	77
手术时间(x±s，min)	185.63±32.72	184.49±34.81	0.135^b	0.893
手术出血(x±s, mL)	87.68±32.33	91.00±31.27	-0.431^b	0.667
白蛋白(x±s, g/L)	41.94±6.56	42.05±7.58	-0.061^b	0.952
TNF-α(x±s, ng/L)	31.80±2.41	31.91±1.83	-0.248^b	0.805
WBC(x±s, ×10⁹/L)	6.97±1.20	6.98±1.54	-0.037^b	0.971
CRP(x±s, mg/L)	7.99±1.53	7.72±1.35	0.807^b	0.421
注：^a为χ²值，^b为t值。

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表 2 2组直肠癌患者外周血相关指标水平比较(x ± s)

Table 2. The levels of peripheral blood related indexes between the two groups(x±s)

组别	例数	TNF-α(ng/mL)		WBC(×10⁹/L)		CRP(mg/L)
组别	例数	术后1 d	术后3 d	术后1 d	术后3 d	术后1 d	术后3 d
IASC	19	54.46±8.35	66.36±11.49	11.28±1.35	8.49±1.16	53.57±5.22	63.53±10.86
非IASC	137	54.28±6.16	49.97±10.46	11.03±1.20	8.37±1.44	53.05±10.14	46.69±11.77
t值		0.115	6.326	0.837	0.365	0.354	5.896
P值		0.909	<0.001	0.404	0.716	0.725	<0.001

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表 3 术后3 d外周血TNF-α及CRP水平对术后IASCs的预测价值

Table 3. The predictive value of TNF-α and CRP in peripheral blood at 3-day after surgery for postoperative IASCs

项目	AUC	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
TNF-α	0.841	79.0	83.9	40.5	96.6
CRP	0.853	68.4	84.7	38.2	95.1

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表 4 ΔTNF-α、术后3 d外周血TNF-α水平及ΔCRP对术后IASC预测价值

Table 4. The predictive value of ΔTNF-α and ΔCRP for postoperative IASCs

项目	AUC	敏感度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
ΔTNF-α	0.896	84.2	97.1	80.0	97.8
ΔCRP	0.856	73.7	91.2	53.8	96.2

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参考文献(18)

[1]	SUNG H, FERLAY J, SIEGEL R L, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2]	郑树, 张苏展, 蔡三军, 等. 中国结直肠肿瘤早诊筛查策略专家共识[J]. 中华胃肠外科杂志, 2018, 21(10): 1081-1086. ZHENG S, ZHANG S Z, CAI S J, et al. Expert consensus on Chinese colorectal cancer screening strategies for early detection[J]. Chin J Gastrointest Surg, 2018, 21(10): 1081-1086.
[3]	王琦, 吴舟桥, 侯士阳, 等. 胃结直肠癌术后腹腔感染性并发症的现状研究(PACAGE研究)[J]. 中华消化外科杂志, 2019, 18(3): 229-234. WANG Q, WU Z Q, HOU S Y, et al. Current status of intra-abdominal infectious complications after surgery for gastric and colorectal cancer (PACAGE study)[J]. Chin J Dig Surg, 2019, 18(3): 229-234.
[4]	程一峰. CRP/Alb比值对胰十二指肠切除术后并发症的预测价值[D]. 乌鲁木齐: 新疆医科大学, 2019. CHENG Y F. Predictive value of CRP/Alb ratio for post-pancreaticoduodenectomy complications[D]. Urumqi: Xinjiang Medical University, 2019.
[5]	李子禹, 吴舟桥, 季加孚. 中国胃肠肿瘤外科术后并发症诊断登记规范专家共识(2018版)[J]. 中国实用外科杂志, 2018, 38(6): 589-595. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201806001.htm LI Z Y, WU Z Q, JI J F. Expert consensus on the diagnosis of postoperative complications in Chinese gastrointestinal oncology (version 2018)[J]. Chinese Journal of Practical Surgery, 2018, 38(6): 589-595. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201806001.htm
[6]	殷洁烽, 张喆, 林聪利. 不同手术方式治疗结直肠癌腹膜转移患者预后效果分析[J]. 中华全科医学, 2018, 16(5): 757-760. doi: 10.16766/j.cnki.issn.1674-4152.000206 YIN J F, ZHANG Z, LIN C L. Outcome analysis of different surgical approaches for patients with colorectal metastases[J]. Chinese Journal of General Practice, 2018, 16(5): 757-760. doi: 10.16766/j.cnki.issn.1674-4152.000206
[7]	曾子威, 康亮. 直肠癌吻合口常见并发症的研究现状[J]. 中华消化外科杂志, 2018, 17(2): 204-207. ZENG Z W, KANG L. Current status of anastomotic complications in rectal cancer[J]. Chinese Journal of Digestive Surgery, 2018, 17(2): 204-207.
[8]	陈伟杰, 林国乐. 直肠癌低位前切除术后吻合口漏诊治现状及展望[J]. 中华胃肠外科杂志, 2021, 24(6): 493-497. CHEN W J, LIN G L. Current status and prospects of anastomotic leakage after low anterior resection for rectal cancer[J]. Chin J Gastrointest Surg, 2021, 24(6): 493-497.
[9]	董明, 周建平, 姚宏伟. 结直肠癌围手术期营养治疗中国专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(6): 533-537. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201906004.htm DONG M, ZHOU J P, YAO H W. Chinese expert consensus on perioperative nutritional therapy for colorectal cancer (2019 edition)[J]. Chinese Journal of Practical Surgery, 2019, 39(6): 533-537. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201906004.htm
[10]	匡荣康, 王成龙, 强光辉, 等. 营养状态对结直肠癌病人手术部位感染的影响及相关因素分析[J]. 肠外与肠内营养, 2021, 28(2): 84-87. https://www.cnki.com.cn/Article/CJFDTOTAL-CWCN202102006.htm KUANG R K, WANG C L, QIANG G H, et al. Effect of nutritional status on surgical site infections in patients with colorectal cancer and correlates[J]. Parenteral & Enteral Nutrition, 2021, 28(2): 84-87. https://www.cnki.com.cn/Article/CJFDTOTAL-CWCN202102006.htm
[11]	中华医学会外科学分会结直肠外科学组. 中国直肠癌手术吻合口漏诊断、预防及处理专家共识(2019版)[J]. 中华胃肠外科杂志, 2019, 22(3): 201-206. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK202001016.htm Colorectal Surgery Group, Surgery Society of Chinese Medical Association, ZHANG Z T. Expert consensus on diagnosis, prevention and management of surgical anastomotic leakage in Chinese rectal cancer (version 2019)[J]. Chin J Gastrointest Surg, 2019, 22(3): 201-206. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWK202001016.htm
[12]	苗儒林, 李子禹, 武爱文. 中国胃肠肿瘤外科联盟数据报告(2014-2016)[J]. 中国实用外科杂志, 2018, 38(1): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801028.htm MIAO R L, LI Z Y, WU A W. Chinese Association of Gastrointestinal Oncology Data Report (2014-2016)[J]. Chinese Journal of Practical Surgery, 2018, 38(1): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801028.htm
[13]	单剑锋, 俞耀军. 腹腔镜下结直肠癌术后感染并发症的特点及危险因素分析[J]. 中华全科医学, 2017, 15(7): 1153-1155. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.018 SHAN J F, YU Y J. Characteristics and risk factors of infectious complications after laparoscopic surgery for colorectal cancer[J]. Chinese Journal of General Practice, 2017, 15(7): 1153-1155. doi: 10.16766/j.cnki.issn.1674-4152.2017.07.018
[14]	姚宏伟, 许峰铭, 安勇博, 等. 直肠癌术后吻合口漏的早期诊断和预防研究进展[J]. 中华胃肠外科杂志, 2021, 24(6): 480-486. YAO H W, XU F M, AN Y B, et al. Advances in the early diagnosis and prevention of postoperative anastomotic leakage in rectal cancer[J]. Chin J Gastrointest Surg, 2021, 24(6): 480-486.
[15]	XIE T B, ZHAO C Y, DING C, et al. Postoperative interleukin-6 predicts intra-abdominal septic complications at an early stage after elective intestinal operation for Crohn ' s disease patients[J]. Inflamm Bowel Dis, 2018, 24(9): 1992-2000.
[16]	金鑫, 张成武, 才保加, 等. C反应蛋白在胃癌术后吻合口漏的预测价值[J]. 青海医药杂志, 2020, 50(6): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-QHYZ202006001.htm JIN X, ZHANG C W, CAI B J, et al. Predictive value of C-reactive protein for anastomotic leakage after gastric surgery[J]. Qinghai Medical Journal, 2020, 50(6): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-QHYZ202006001.htm
[17]	李柱, 廖信芳, 吕海钠, 等. 血清CRP、腹腔引流液CRP在预测腹腔镜结直肠癌术后吻合口瘘的临床价值[J]. 广州医科大学学报, 2021, 49(3): 77-82. https://www.cnki.com.cn/Article/CJFDTOTAL-GZXI202103016.htm LI Z, LIAO X F, LYU H N, et al. Clinical utility of serum CRP and intraperitoneal drainage solution CRP in predicting anastomotic leakage after laparoscopic colorectal cancer surgery[J]. Academic Journal of Guangzhou Medical University, 2021, 49(3): 77-82. https://www.cnki.com.cn/Article/CJFDTOTAL-GZXI202103016.htm
[18]	DAS U, ANANDHI A, SURESHKUMAR S, et al. Procalcitonin and C-reactive protein as an early predictor of infection in elective gastrointestinal cancer surgery-a prospective observational study[J]. J Gastrointest Cancer, 2022, 53(3): 605-613.