肺癌肺叶切除患者术前存在气道定植菌与术后肺炎的发生有相关性吗?

背景与目的 外科手术是目前治疗肺癌的主要手段,肺癌患者围术期死亡的主要原因仍是术后肺炎.已有的研究结果显示致病性气道定植菌被认为是术后肺部并发症的一个独立危险因素,本研究旨在探讨术前致病性气道定植菌的存在与术后发生肺炎的关系及其危险因素.方法 横断面调查2014年5月至2015年1月连续收治于成都市6家三级甲等医院胸外科行手术治疗的125例非小细胞肺癌患者,术前经纤维支气管镜取气管及支气管内液细菌学标本,并检测术前血清肺表面活性蛋白D(surfactant protein D,SP-D)水平,术后肺部相关并发症进行分析.结果 肺癌患者术前合并致病性气道定植菌的发生率为15.2％(19/125),以革兰氏阴性菌为主(19/22,86.36％);肺癌患者术前合并致病性气道定植菌的高危因素为:高龄(≥75岁)和长期吸烟史(吸烟指数≥≥400支/年);术后肺部相关并发症和术后肺炎发生率在肺癌合并致病性气道定植菌组(42.11％,26.32％)均显著高于非合并组(16.04％,6.60％)(P=0.021,P=0.019).术前血清SP-D浓度在肺癌合并致病性气道定植菌(31.25±6.09)显著高于非合并组(28.17±5.23)(P=0.023).并发术后肺炎患者中气道致病性定值菌发生率为41.67％(5/12),其发生率是无手术后肺炎患者的3.4倍(OR=3.363,95％CI:1.467-7.711).结论 肺癌患者合并致病性气道定植菌与术后肺炎发生密切相关,且高危险因素是高龄和长期吸烟史.

Preoperatiove Airway Bacterial Colonization: the Missing Link between Non-small Cell Lung Cancer Following Lobectomy and Postoperative Pneumonia?

Background and objective Surgical procedure is the main method of treating lung cancer.Meanwhile,postoperative pneumonia (POP) is the major cause of perioperative mortality in lung cancer surgery.The preoperative pathogenic airway bacterial colonization is an independent risk factor causing postoperative pulmonary complications (PPC).This cross-sectional study aimed to explore the relationship between preoperative pathogenic airway bacterial colonization and POP in lung cancer and to identify the high-risk factors of preoperative pathogenic airway bacterial colonization.Methods A total of 125 patients with non-small cell lung cancer (NSCLC) underwent thoracic surgery in six hospitals of Chengdu between May 2015 and January 2016.Preoperative pathogenic airway bacterial colonization was detected in all patients via fiber bronchoscopy.Patients' PPC,high-risk factors,clinical characteristics,and the serum surfactant protein D (SP-D) level were also analyzed.Results The incidence of preoperative pathogenic airway bacterial colonization among NSCLC patients was 15.2％ (19/125).Up to 22 strains were identified in the colonization positive group,with Gram-negative bacteria being dominant (86.36％,19/22).High-risk factors of pathogenic airway bacterial colonization were age (≥75 yr) and smoking index (≥≥400 cigarettes/year).PPC incidence was significantly higher in the colonization-positive group (42.11％,8/19) than that in the colonization-negative group (16.04％,17/106)(P=0.021).POP incidence was significantly higher in the colonization-positive group (26.32％,5/19) than that in the colonization-negative group (6.60％,7/106)(P=0.019).The serum SP-D level of patients in the colonization-positive group was remarkably higher than that in the colonization-negative group (31.25±6.09)vs (28.17±5.23)] (P=0.023).The incidence of preoperative pathogenic airway bacterial colonization among NSCLC patients with POP was 41.67％ (5/12).Ihis value was 3.4 times higher than that among the patients without POP (OR=3.363,95％CI:1.467-7.711).Conclusion An intimate correlation was observed between POP and pathogenic airway bacterial colonization in lung cancer.The high-risk factors of pathogenic airway bacterial colonization were age and smoking index.