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中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 257 -262. doi: 10.3877/cma.j.issn.1674-1358.2021.04.007

论著

血清肝素结合蛋白、C-反应蛋白和降钙素原对肺癌电视胸腔镜术后肺部细菌感染的预测价值
王伟1,†(), 王坤1, 孙涛1, 茹玉航1, 刘晓1   
  1. 1. 236800　亳州市，亳州市人民医院胸外科
  • 收稿日期:2020-08-31 出版日期:2021-08-15
  • 通信作者: 王伟
  • 基金资助:
    安徽省高等学校省级质量工程教学项目(No. 2018jyxm04)

Predictive value of serum heparin binding protein, C-reactive protein and procalcitonin for pulmonary bacterial infection after video-assisted thoracoscopic surgery for lung cancer

Wei Wang1,†(), Kun Wang1, Tao Sun1, Yuhang Ru1, Xiao Liu1   

  1. 1. Department of Chest Surgery, Bozhou People’s Hospital, Bozhou 236800, China
  • Received:2020-08-31 Published:2021-08-15
  • Corresponding author: Wei Wang
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引用本文：

王伟, 王坤, 孙涛, 茹玉航, 刘晓. 血清肝素结合蛋白、C-反应蛋白和降钙素原对肺癌电视胸腔镜术后肺部细菌感染的预测价值[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(04): 257-262.

Wei Wang, Kun Wang, Tao Sun, Yuhang Ru, Xiao Liu. Predictive value of serum heparin binding protein, C-reactive protein and procalcitonin for pulmonary bacterial infection after video-assisted thoracoscopic surgery for lung cancer[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(04): 257-262.

目的

探讨血清肝素结合蛋白（HBP）、C-反应蛋白（CRP）和降钙素原（PCT）对肺癌患者电视胸腔镜手术（VATS）术后肺部细菌感染的预测价值。

方法

回顾性分析2017年3月至2020年7月亳州市人民医院收治的105例肺癌患者的临床资料。统计肺癌患者VATS术后肺部细菌感染发生率；根据术后是否发生肺部细菌感染将患者分为感染组（18例）与对照组（87例），比较两组患者术后即刻、术后24 h血清HBP、CRP和PCT水平及变化率；绘制受试者工作特征曲（ROC）分析血清HBP、CRP和PCT水平变化率及三者联合预测肺癌患者VATS术后肺部细菌感染的价值。

结果

肺癌患者VATS术后肺部细菌感染的发生率为17.14%（18/105）；与术后即刻相比，术后24 h两组患者血清HBP、CRP和PCT水平均升高[感染组：（12.52 ± 1.53）ng/ml vs.（8.16 ± 1.25）ng/ml，t = 9.363、P < 0.001；（41.83 ± 4.75）mg/ml vs.（21.68 ± 2.18）mg/ml，t = 16.357、P < 0.001；（1.21 ± 0.21）ng/ml vs.（0.32 ± 0.04）ng/ml，t = 17.663、P < 0.001。对照组：（9.94 ± 1.47）ng/ml vs.（7.91 ± 1.17）ng/ml，t = 10.078、P < 0.001；（31.62 ± 3.37）mg/ml vs.（21.27 ± 2.02）mg/ml，t = 24.571、P < 0.001；（0.65 ± 0.07）ng/ml vs.（0.34 ± 0.06）ng/ml，t = 31.363、P < 0.001]；且感染组患者均显著高于对照组（t = 6.732、10.850、20.282，P均< 0.001），差异均有统计学意义。术后即刻至术后24 h感染组患者血清HBP[（53.43 ± 6.82）vs.（25.66 ± 4.51）%]、CRP[（92.94 ± 8.73）% vs.（48.66 ± 6.12）%]和PCT[（278.13 ± 34.75）% vs. （91.18 ± 10.36）%]变化率均高于对照组，差异均有统计学意义（t = 21.596、25.824、42.475，P均< 0.001）。血清HBP、CRP、PCT变化率单独与联合预测肺癌患者VATS术后肺部细菌感染发生的ROC分析显示，血清HBP、CRP、PCT变化率预测肺癌患者VATS术后肺部细菌感染的最佳截断点分别为32.93%、71.65%和128.75%；血清HBP、CRP、PCT三者水平变化率联合预测肺癌患者VATS术后肺部细菌感染的曲线下面积（AUC）为0.848，高于血清HBP（AUC：0.689）、CRP（AUC：0.656）和PCT变化率（AUC：0.612）单独预测的AUC（Z = 2.392、P = 0.017，Z = 2.601、P = 0.009，Z = 2.013、P = 0.048）。

结论

VATS术后即刻至术后24 h，肺癌患者VATS术后发生肺部细菌感染者血清HBP、和CRP和PCT水平升高变化率均高于未发生肺部细菌感染者；血清HBP、CRP和PCT三者水平变化率联合预测肺癌患者VATS术后肺部细菌感染的效能高于各单一指标变化率。

关键词: 肝素结合蛋白, C-反应蛋白, 降钙素原, 肺癌, 肺部细菌感染, 术后并发症, 电视胸腔镜
Objective

To investigate the predictive value of serum heparin-binding protein (HBP), C-response protein (CRP), and procalcitonin (PCT) for pulmonary bacterial infection of patients with lung cancer after video assisted thoracoscopic surgery.

Methods

Clinical data of 105 patients with lung cancer admitted to Bozhou People’s Hospital from March 2017 to July 2020 were analyzed, retrospectively. The incidence rate of pulmonary bacterial infection of patients with lung cancer after VATS was analyzed. The patients were divided into infection group (18 cases) and control group (87 cases) according to whether occurred pulmonary bacterial infection after operation, and the levels of serum HBP, CRP and PCT were compared between the two group immediately and 24 hours after operation. The predictive value of change rates of serum HBP, CRP, PCT levels and the combination of the three indexes on pulmonary bacterial infection for patients with lung cancer after VATS were analyzed by receiver operating characteristic curve (ROC).

Results

The incidence rate of pulmonary infection after VATS was 17.14% (18/105). The levels of serum HBP, CRP and PCT of the two groups increased at 24 hours after operation compared with those immediately after operation, [Infection group: (12.52 ± 1.53) ng/ml vs. (8.16 ± 1.25) ng/ml; t = 9.363, P < 0.001. (41.83 ± 4.75) mg/ml vs. (21.68 ± 2.18) mg/ml; t = 16.357, P < 0.001. (1.21 ± 0.21) ng/ml vs. (0.32 ± 0.04) ng/ml; t = 17.663, P < 0.001. Control group: (9.94 ± 1.47) ng/ml vs. (7.91 ± 1.17) ng/ml; t = 10.078, P < 0.001. (31.62 ± 3.37) mg/ml vs. (21.27 ± 2.02) mg/ml; t = 24.571, P < 0.001. (0.65 ± 0.07) ng/ml vs. (0.34 ± 0.06) ng/ml; t = 31.363, P < 0.001], which were significantly higher of patients in infection group than those of control group (t = 6.732, 10.850, 20.282; all P < 0.001). The change rates of serum HBP, CRP and PCT of infection group were significantly higher than those of control group [(53.43 ± 6.82)% vs. (25.66 ± 4.51)%, (92.94 ± 8.73)% vs. (48.66 ± 6.12)%, (278.13 ± 34.75) % vs. (91.18 ± 10.36)%], with significant differences (t = 21.596, P < 0.001; t = 25.824, P < 0.001; t = 42.475, P < 0.001). ROC analysis on predicting pulmonary bacterial infection after VATS for patients with lung cancer showed that the best cut-off points of change rates of serum HBP, CRP and PCT were 32.93%, 71.65% and 128.75%, respectively. The area under curve (AUC) of the combined three indexes on predicting pulmonary bacterial infection after VATS was 0.848, which was higher than those of serum HBP (0.689), CRP (0.656) and PCT (0.612) (Z = 2.392, P = 0.017; Z = 2.601, P = 0.009; Z = 2.013, P = 0.048).

Conclusions

The increasing change rates of serum HBP, CRP and PCT levels of patients with pulmonary bacterial infection after VATS were higher than those of patients without pulmonary infection immediately and 24 hours after VATS. The combination of change rates of serum HBP, CRP and PCT levels was more suitable for predicting pulmonary bacterial infection of patients with lung cancer after VATS than those of single index.

Key words: Heparin binding protein, C-reactive protein, Procalcitonin, Lung cancer, Pulmonary bacterial infection, Postoperative complications, Video assisted thoracoscopy
表1 入组105例肺癌患者的一般资料
一般资料 数值
性别[例（%）]  
  男 63（60.00）
  女 42（40.00）
平均年龄（± s，岁） 48.65 ± 5.73
肺癌种类（周围型） [例（%）] 105（100.00）
肺癌病理类型[例（%）]  
  腺癌 83（79.05）
  鳞癌 13（12.38）
  腺鳞癌 9（8.57）
肺癌分期[例（%）]  
  Ⅰ期 73（69.52）
  Ⅱ期 32（30.48）
合并基础疾病[例（%）]  
  高血压 27（25.71）
  糖尿病 21（20.00）
  脑血管病 6（5.71）
  其他 4（3.81）
饮酒史[例（%）] 55（52.38）
吸烟史[例（%）] 47（44.76）
表2 感染组和对照组患者术后即刻、术后24 h血清HBP、CRP和PCT水平及变化率（± s）
组别 例数 HBP CRP PCT
术后即刻（ng/ml） 术后24 h （ng/ml） 变化率（%） 术后即刻（mg/ml） 术后24 h （mg/ml） 变化率（%） 术后即刻（ng/ml） 术后24 h （ng/ml） 变化率（%）
感染组 18 8.16 ± 1.25 12.52 ± 1.53 53.43 ± 6.82 21.68 ± 2.18 41.83 ± 4.75 92.94 ± 8.73 0.32 ± 0.04 1.21 ± 0.21 278.13 ± 34.75
对照组 87 7.91 ± 1.17 9.94 ± 1.47 25.66 ± 4.51 21.27 ± 2.02 31.62 ± 3.37 48.66 ± 6.12 0.34 ± 0.06 0.65 ± 0.07 91.18 ± 10.36
t值   0.816 6.732 21.596 0.773 10.850 25.824 1.351 20.282 42.475
P值   0.417 < 0.001 < 0.001 0.441 < 0.001 < 0.001 0.180 < 0.001 < 0.001
图1 血清HBP、CRP、PCT变化率及三者联合预测肺癌患者VATS术后肺部细菌感染的ROC图
表3 血清HBP、CRP、PCT变化率及三者联合对肺癌患者VATS术后肺部细菌感染的预测价值
检测指标 最佳截断点（%） 灵敏度（%） 特异度（%） AUC 95%CI
血清HBP变化率 32.93 88.89（16/18） 59.77（52/87） 0.689 0.591~0.775
CRP变化率 71.65 83.33（15/18） 62.07（54/87） 0.656 0.557~0.746
PCT变化率 128.75 72.22（13/18） 72.41（63/87） 0.612 0.512~0.706
联合 — 72.22（13/18） 98.85（86/87） 0.848 0.765~0.911
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