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目的分析结肠癌手术后早期免疫学指标变化,探讨结肠癌手术后易引起肺部感染的免疫学因素。方法将2007年9月至2009年12月6例结肠癌手术后肺部感染患者分为术后肺部感染组;2008年6月至2009年12月,29例结肠癌手术后无肺部感染患者分为无术后肺部感染组;急性肺炎患者25例为急性肺炎组,30名健康成年人为健康对照组。腹部手术组在手术前、术后第3天及第7天采外周静脉血,健康对照组在体检时采血,肺部感染组在入院时采血。酶联免疫吸附试验(ELISA)法检测各组干扰素(IFN)-γ、白细胞介素(IL)-4。记录一般临床检验指标。比较各组间IFN-γ、IL-4、IFN-γ/IL-4,以及一般临床指标。结果腹部手术各组术后第3、7天IFN-γ/IL-4的比值均明显低于健康对照组(P<0.05)。腹部手术后无肺部感染组与急性肺炎患者的IFN-γ/IL-4的比值差异无统计学意义(P>0.05),但均明显低于健康对照组(P<0.05)。结论手术后7d内,Th1/Th2细胞因子比率失调,与肺部感染的Th1/Th2细胞因子比率相似。术后早期Th1/Th2免疫反应失调可能是腹部手术后肺部感染的免疫学基础。
Objective To analyze the changes of immunological parameters in the early postoperative period of colon cancer and explore the immunological factors that cause lung infection after colon cancer surgery. Methods From September 2007 to December 2009, 6 patients with colon cancer after lung cancer were divided into postoperative pulmonary infection group; from June 2008 to December 2009, 29 patients with colon cancer had no pulmonary infection after surgery. Patients were divided into no postoperative pulmonary infection group; 25 patients with acute pneumonia were acute pneumonia and 30 healthy adults were healthy controls. In the abdominal surgery group, peripheral venous blood was collected before surgery and on the 3rd and 7th days after surgery. The healthy control group collected blood during physical examination and the pulmonary infection group collected blood on admission. Enzyme-linked immunosorbent assay (ELISA) was used to detect interferon (IFN)-γ and interleukin (IL)-4 in each group. Record general clinical testing indicators. IFN-γ, IL-4, IFN-γ/IL-4, and general clinical parameters were compared between groups. Results The ratios of IFN-γ/IL-4 on the 3rd and 7th days after operation in all groups were significantly lower than those in the healthy control group (P<0.05). There was no significant difference in the ratio of IFN-γ/IL-4 between patients without pulmonary infection and acute pneumonia after abdominal surgery (P>0.05), but they were significantly lower than those in healthy controls (P<0.05). Conclusion Within 7 days after surgery, the ratio of Th1/Th2 cytokines is deregulated, which is similar to the ratio of Th1/Th2 cytokines in lung infection. Disturbance of the Th1/Th2 immune response early after surgery may be the immunological basis of lung infections after abdominal surgery.