结直肠癌合并糖尿病患者术后感染对机体Th17相关因子、sICAM－1、MMP－12表达的影响

目的探讨分析结直肠癌合并糖尿病患者术后感染对机体辅助性T细胞17(Th17)相关因子、可溶性细胞间黏附分子－1(sICAM－1)、基质金属蛋白酶－12(MMP－12)表达的影响。 方法回顾性分析2015年8月至2018年8月行结直肠癌根治术且合并2型糖尿病患者117例资料，采用ROC曲线分析IL－17、sICAM－1及MMP－12对患者术后感染的预测价值。采用SPSS 22.0统计软件进行数据分析，Th17、Treg细胞等水平比较采用t检验，计数资料比较采用χ²检验，采用ROC曲线分析IL－17、sICAM－1及MMP－12对患者术后感染的预测价值，以P<0.05为差异统计学意义。 结果117例患者31例发生术后感染(26.5%)，共分离病原菌38株，革兰阴性菌24株(63.2%)、革兰阳性菌13株(34.2%)、真菌1株(2.6%)。感染组外周血Th17、Th17/Treg显著高于未感染组(P<0.05)，外周血Treg细胞显著低于未感染组(P<0.05)，血清IL－17、sICAM－1、MMP－12水平显著高于未感染组(P<0.05)。IL－17、sICAM－1及MMP－12术后感染预测价值ROC曲线下面积分别为0.814、0.867、0.742(P<0.05)。 结论结直肠癌合并糖尿病术后感染可致机体Th17/Treg失衡，引发自身免疫应答及炎症反应，引起血清IL－17、sICAM－1、MMP－12水平升高，血清IL－17、sICAM－1、MMP－12检测可作为术后感染早期诊断指标。

Clinical observation of the expression of Th17-related factors,sICAM-1 and MMP-12 in patients with postoperative infection and diabetes mellitus after colorectal cancer surgery

ObjectiveTo investigate the expression of Th17-related factors, sICAM-1 and MMP-12 in patients with postoperative infection and diabetes mellitus after colorectal cancer surgery. MethodsFrom August 2015 to August 2018, clinical data of 117 patients with type 2 diabetes mellitus who underwent radical resection of colorectal cancer were analyzed retrospectively. ROC curve was used to analyze the predictive value of IL-17, sICAM-1 and MMP-12 for postoperative infection. SPSS 22.0 statistical software was used for data analysis. Th17 and Treg cell level were expressed as ( ±s) and were examined by independent t test. ROC curve was used to analyze the predictive value of IL-17, sICAM-1 and MMP-12 for postoperative infection. A P value of <0.05 was considered as statistically significant. ResultsAmong the 117 patients, postoperative infection occurred in 31 cases(26.5%). There were 38 strains of pathogenic bacteria in 31 patients with postoperative infection, including 24 strains of Gram-negative bacteria (63.2%), 13 strains of Gram-positive bacteria (34.2%) and 1 strain of fungi (2.6%). Th17 and Th17/Treg in peripheral blood of infected group were significantly higher than those of uninfected group (P<0.05). Treg cells in peripheral blood of infected group were significantly lower than those of uninfected group (P<0.05). The levels of serum IL-17, sICAM-1 and MMP-12 in the infection group were significantly higher than those in the non-infected group respectively(P<0.05). ROC curve was used to analyze the predictive value of IL-17, sICAM-1 and MMP-12 for postoperative infection. The scores under each index curve were 0.814, 0.867 and 0.742 respectively (P<0.05). ConclusionsThe postoperative infection in patients with colorectal cancer and diabetes could cause imbalance of Th17/Treg, triggers the autoimmune response and inflammation, elevate the level of serum IL-17、sICAM-1 and MMP-12.The indexes of serum IL-17、sICAM-1 and MMP-12 could be used as the early diagnostic indexes for postoperative infection.