晚期非小细胞肺癌患者恶性肿瘤组织中定植菌群研究

宋国锋

[摘要] 目的 探討晚期非小细胞肺癌（Non-small cell lung cancer，NSCLC）患者恶性肿瘤组织中定植菌群情况，分析气道定植菌群与NSCLC发生发展的关系。 方法 回顾性研究2017年1月～2018年10月我院行肺叶切除手术的NSCLC患者212例，肺癌标本采集于癌性病变部位及毗邻癌性病变的正常组织，分析细菌定植情况。根据是否存在定植菌群分为定植组32例和非定植组180例。对两组患者细菌取样培养和SP-D水平检测。 结果 NSCLC患者中有15.09%（32/212）患者存在定植菌群，而正常组织有3.77%（8/212）存在定植菌群，肺癌组织中定植菌发生率明显高于正常组织（P<0.05）。两组菌群分布以肺炎链球菌、肺炎克雷伯菌多见。定植组SP-D水平明显高于非定植组（P<0.05）。相关性分析显示，血清SP-D水平与致病性定植菌发生呈正相关，相关系数为0.215（P=0.023）。术后定植组并发症发生率明显高于非定植组（P<0.05），而定植组以肺部感染为主要并发症，肺部感染发生率明显高于非定植组（P<0.05）。 结论 细菌定植与肺癌的发生具有一定的相关性，肺癌患者合并致病性定植菌与术后并发症发生密切相关，血清SP-D水平与患者术前致病菌定植状态相关。

[关键词] 非小细胞肺癌;肺组织;定植菌;血清SP-D

[中图分类号] R734.2;R563.1          [文献标识码] B          [文章编号] 1673-9701（2020）16-0128-04

Study on colonizing flora in malignant tumor tissue of patients with advanced non-small cell lung cancer

SONG Guofeng

Department of Laboratory Medicine， Jiamusi Cancer Hospital in Heilongjiang Province， Jiamusi   154007， China

[Abstract] Objective To explore the colonizing flora of malignant tumor tissues in patients with advanced non-small cell lung cancer（NSCLC）， and to analyze the relationship between colonizing flora of airways and the occurrence and development of NSCLC. Methods A retrospective study  of 212 patients with NSCLC who underwent lobectomy in our hospital from January 2017 to October 2018 were collected. Lung cancer specimens were collected at the cancerous lesion and normal tissue adjacent to the cancerous lesion. The bacterial colonization was analyzed. According to the presence of colonizing bacteria， the patients were divided into  colonizing bacteria group（n=32） and non-colonizing bacteria group（n=180）. The bacteria sampling was cultured and SP-D level was detected in two groups. Results 15.09%（32/212） of NSCLC patients had colonizing flora， while 3.77%（8/212） of normal tissue had colonizing flora. The incidence of colonizing bacteria in lung cancer tissue was significantly higher than that of normal tissue（P<0.05）. The distribution of bacteria in the two groups was more common with Streptococcus pneumoniae and Klebsiella pneumoniae. The SP-D level in the colonizing-bacteria group was significantly higher than that in the non-colonizing bacteria group（P<0.05）. Correlation analysis showed that the serum SP-D level was positively correlated with the occurrence of pathogenic colonizing bacteria， with a correlation coefficient of 0.215（P=0.023）. The postoperative complications rate of colonizing-bacteria group were significantly higher than the non-colonizing bacteria group（P<0.05）. While the colonizing-bacteria group had lung infection as the main complication， and the incidence of lung infection in the colonizing-bacteria group was significantly higher than that of the non-colonizing bacteria group（P<0.05）. Conclusion Bacterial colonization has a certain correlation with the occurrence of lung cancer. Lung cancer combined with pathogenic colonization bacteria is closely related to postoperative complications. Serum SP-D level is related to the preoperative colonization status of pathogenic bacteria.

[Key words] Non-small cell lung cancer; Lung tissue; Colonizing bacteria; Serum SP-D

肺癌是我国高死亡率的恶性肿瘤之一[1]，近年来发病率持续攀升，发病年龄缩小，其中80%～85%为非小细胞肺癌（Non-small cell lung cancer，NSCLC）[2]。NSCLC的发生是机体易感性与环境因素共同作用的结果[3]。近年来，随着分子生物学的发展，气道定植菌群作为重要环境因素在NSCLC发生、进展过程中的作用越来越受到重视[4]。目前，已有研究证实术前致病性气道细菌定植是导致术后肺部并发症的独立危险因素。但对于气道细菌定植与肺癌发生之间的关系探讨较少。为此，本研究探讨了晚期非小细胞肺癌患者恶性肿瘤组织中定植菌群情况，分析气道定植菌群与NSCLC发生发展的关系，现报道如下。

1 资料与方法

1.1 一般资料

采用回顾性分析法，选取我院2017年1月～2018年10月诊治的212例NSCLC患者作为调查对象。其中男120例，女92例，平均年龄（52.94±8.47）岁，癌症类型：鳞癌118例，腺癌94例。临床分期：Ⅰ期80例，Ⅱ期132例。……