子宫内膜癌术后感染影响因素及程序性死亡受体-1的预测价值

目的探索子宫内膜癌术后感染的影响因素及程序性死亡受体-1(PD-1)的预测价值。方法选择2017年2月-2020年2月于浙江省衢州市妇幼保健院接受治疗的126例子宫内膜癌患者为研究对象。根据患者术后是否发生感染分为感染组(n=24)和未感染组(n=102)。观察并分析两组一般资料,对比手术出血量、手术时间、住院时间、1个月内病死率和不同时间点PD-1+CD3⁺细胞比例变化情况。结果感染组简化急性生理评分(SAPSⅡ)低于未感染组(P<0.05)。感染组与未感染组手术时间、住院时间比较,无统计学差异;感染组手术出血量、1个月内病死率高于未感染组(P<0.05)。感染组与未感染组术前PD-1+CD3⁺细胞比例比较,无统计学差异;感染组术后1 d、术后3 d、术后7 d PD-1+CD3⁺细胞比例与未感染组相比较上升(P<0.05)。SAPSⅡ评分、PD-1+CD3⁺细胞比例是影响子宫内膜癌妇女术后感染的独立危险因素(P<0.05)。PD-1+CD3⁺细胞比例对子宫内膜癌妇女术后感染的预测效能较高,接收者工作特征曲线(ROC)下面积(0.95%CI)为0.788(0.665~0.933)。结论子宫内膜癌患者发生感染后SAPSⅡ评分具有较大的变化,术后感染患者手术出血量和1个月内病死率较高,且术后感染发生后PD-1+CD3⁺细胞比例变化明显。

Influencing factors for postoperative infection in patients with endometrial cancer and predictive value of programmed death receptor-1

OBJECTIVE To explore the influencing factors for postoperative infection in the patients with endometrial cancer and analyze the predictive value of programmed death-1(PD-1).METHODS A total of 126 patients with endometrial cancer who were treated in Quzhou Maternal and Child Health Hospital from Feb 2017 to Feb 2020 were recruited as the study subjects and divided into the infection group with 24 cases and the non-infection group with 102 cases according to the status of postoperative infection.The baseline data of the patients were observed,the intraoperative blood loss volume,operation duration,length of hospital stay,mortality rate within 1 month and percentages of PD-1+CD3⁺at different time points were compared between the two groups of patients.RESULTS Simplified Acute Physiology Scoring(New Simplified Acute Physiology Score,SAPSⅡ)score of the infection group was significantly lower than that of the non-infection group(P<0.05).There were no significant differences in the operation duration and length of hospital stay between the infection group and the non-infection group.The intraoperative blood loss volume and mortality rate within 1 month were significantly higher in the infection group than in the non-infection group(P<0.05).There was no significant difference in the percentage of preoperative PD-1+CD3⁺cell between the infection group and the non-infection group.The percentage of PD-1+CD3⁺cell of the infection group was significantly higher than that of the non-infection group after the surgery for 1,3 and 7 days(P<0.05).SAPSⅡscore and percentage of PD-1+CD3⁺cell were independent risk factors for the postoperative infection in the women with endometrial cancer(P<0.05).The percentage of PD-1+CD3⁺cell was highly efficient in prediction of postoperative infection in the women with endometrial cancer,and the area(0.95%CI)under receiver operating characteristic(ROC)curve was 0.788(0.665~0.933).CONCLUSION The SAPSⅡscore of the endometrial cancer patients with postoperative infection has great change,the intraoperative blood loss volume and mortality rate within 1 month of the patients with postoperative infection are high,and the percentage of PD-1+CD3⁺cell has great change.