乳腺癌术后放射性肺炎合并肺部感染病原菌及Th17/Treg水平

目的探讨乳腺癌术后放射性肺炎合并肺部感染病原菌及辅助型T细胞17(Th17)和调节型T细胞(Treg)的改变分析。方法选择绍兴文理学院附属医院普外三科2017年1月-2019年12月收治的乳腺癌术后放射性肺炎合并肺部感染患者36例作为研究对象,纳入感染组。选择同期医院收治的乳腺癌术后无放射性肺炎患者30例,纳入非感染组,选择同期医院收治的良性乳腺肿瘤患者30例纳入对照组。对感染组患者病原菌进行分析。采用酶联免疫吸附法检测三组研究对象血清中白细胞介素-17(IL-17)、IL-23、干扰素-γ(IFN-γ)、转化生长因子-β(TGF-β)水平,并进行比较。结果 36例放射性肺炎合并肺部感染的乳腺癌患者共检出病原菌41株,其中革兰阴性菌23例占56.10%,革兰阳性菌16株占39.02%,真菌2株占4.88%。感染组IL-17、IL-23为(68.64±18.29)pg/ml、(89.07±23.20)pg/ml高于非感染组(48.58±14.27)pg/ml、(70.28±21.82)pg/ml及对照组,IFN-γ、TGF-β为(14.67±5.51)pg/ml、(18.37±6.40)pg/ml低于非感染组(27.24±11.21)pg/ml、(29.40±12.08)pg/ml及对照组(P均<0.001),非感染组及对照组之间IL-17、IL-23、IFN-γ、TGF-β水平差异无统计学意义。放射性肺炎0~1级12例、2级16例、3~4级8例,3~4级患者IL-17、IL-23为(83.86±16.04)pg/ml、(103.25±17.80)pg/ml高于2级患者(69.60±14.69)pg/ml、(87.68±16.20)pg/ml及0~1级患者,IFN-γ、TGF-β为(9.85±3.52)pg/ml、(11.37±2.99)pg/ml低于2级患者(14.97±5.50)pg/ml、(15.07±3.81)pg/ml及0~1级患者(P均<0.05),2级患者IL-17、IL-23水平高于0~1级患者、IFN-γ、TGF-β水平低于0~1级患者(P<0.05)。结论乳腺癌术后放射性肺炎感染病原以革兰阴性菌为主,应根据病原培养结果进行针对性用药,通过IL-17、IL-23、IFN-γ、TGF-β水平用于2级以上放射性肺炎诊断具有一定的临床价值。

Pathogenic bacteria and Th17/Treg changes in patients with radiation-induced pneumonia complicated with lung infection after breast cancer

OBJECTIVE To explore the changes of pathogenic bacteria, helper T cells 17(Th17) and regulatory T cells(Treg) of patients with radiation-induced pneumonia and lung infection after breast cancer surgery. METHODS Thirty-six patients with radiation pneumonia and lung infection after breast cancer surgery who were admitted to the Third Department of General Surgery of the Affiliated Hospital of Shaoxing University of Arts and Sciences from Jan. 2017 to Dec. 2019 were selected as the research subjects and included in the infection group. Thirty patients with no radiation pneumonia after breast cancer surgery were selected in the hospital during the same period and included in the non-infected group, and 30 patients with benign breast cancer admitted in the hospital during the same period were included in the control group. The pathogenic bacteria in the infected group were analyzed. The levels of interleukin-17(IL-17), IL-23, interferon-γ(IFN-γ) and transforming growth factor-β(TGF-β) in the serum of three groups of subjects were detected by enzyme-linked immunosorbent assay and compared. RESULTS A total of 41 strains of pathogenic bacteria were detected in 36 breast cancer patients with radiation pneumonia and lung infection, of which 23 strains of gram-negative bacteria accounted for 56.10%, 16 strains of gram-positive bacteria accounted for 39.02%, and 2 strains of fungi accounted for 4.88%. The levels of IL-17 and IL-23 in the infected group were(68.64±18.29)pg/ml and(89.07±23.20)pg/ml, respectively, significantly higher than those in the non-infected group(48.58±14.27 pg/ml and 70.28±21.82 pg/mL, respectively) and the control group;IFN-γ, TGF-β were(14.67±5.51)pg/ml and(18.37±6.40)pg/ml, respectively, significantly lower than those of the non-infected group(27.24±11.21 pg/ml and 29.40±12.08 pg/mL, respectively) and control group(P<0.001). There was no significant difference in the levels of IL17, IL-23, IFN-γ, and TGF-β between the non-infected group and the control group. There were 12 cases of radiation pneumonitis 0~1 grade, 16 cases of grade 2 and 8 case of grade 3~4. The levels of IL-17 and IL-23 in grade 3~4 patients were(83.86±16.04)pg/ml and(103.25±17.80)pg/ml, respectively, significantly higher than those in grade 2 patients(69.60±14.69 pg/ml and 87.68±16.20 pg/ml, respectively) and grade 0~1 patients;IFN-γ and TGF-β were(9.85±3.52)pg/ml and(11.37±2.99)pg/ml, respectively, significantly lower than those of grade 2 patients(14.97±5.50 pg/ml and 15.07±3.81 pg/ml, respectively)and grade 0~1 patients(P<0.05). The levels of IL-17 and IL-23 in grade 2 patients were significantly higher than those in grade 0~1 patients, and the levels of IFN-γ and TGF-β was significantly lower than those in grade 0~1 patients(P<0.05). CONCLUSION Gram-negative bacteria were the main pathogens of radiation pneumonitis infection after breast cancer surgery, and targeted medication should be carried out according to the results of pathogen culture. The levels of IL17, IL-23, IFN-γ, and TGF-β levels were used in the diagnosis of radiation pneumonia above grade 2 and had certain clinical value.