结直肠癌手术后患者血浆降钙素原、C反应蛋白、肿瘤坏死因子α水平的变化与术后肠梗阻的关系

摘要

Objective To investigate the relationship between plasma levels of procalcitonin (PCT),C-reactive protein(CRP) and tumor necrosis factor-alpha(TNF-cα) and postoperative intestinal obstruction in patients with colorectal cancer.Methods From December 2014 to December 2017,60 patients with colorectal cancer and 60 patients who had no intestinal obstruction after operation in the Third Hospital of Shanxi Datong Coal Mine Group Limited Company were selected.The patients were divided into intestinal obstruction group and non-intestinal obstruction group.All the patients received blood examination,and the levels of PCT,CRP and TNF-α were measured.The levels of PCT,CRP and TNF-α were compared between the obstruction group and the non-intestinal obstruction group before operation,1 day after operation and 5 days after operation.The levels of PCT,CRP and TNF -α in patients with intestinal obstruction were compared at different time points after operation.According to the outcomeon the 5th day after operation,the patients in the intestinal obstruction group were divided into effective group and ineffective group,and the levels of PCT,CRP and TNF-α were compared between the effective group and the ineffective group.Pearson correlation analysis was used to analyze the correlation between the levels of PCT,CRP and TNF-α with postoperative intestinal obstruction in patients with colorectal cancer.Results At preoperative 1 d and postoperative 1 d,the PCT,CRP and TNF-α levels between the intestinal obstruction group and non-intestinal obstruction group had no statistically significant differences(preoperation t =0.706,0.459,0.249,postoperative 1 day t =0.874,0.434,1.460,all P ＞ 0.05).At 5 days after surgery,the levels of PCT[(1.89 ± 0.53) ng/mL],CRP [(10.06 ± 2.50) mg,/L],TNF-α[(1.95 ± 0.59) ng/L] in the intestinal obstruction group were higher than those in the non-intestinal obstruction group [(1.05 ± 0.32) ng/mL,(7.27 ± 2.06) mg/L,(1.15 ± 0.28) ng/L,t =10.51 0,6.671,9.489,all P ＜ 0.05].The levels of PCT,CRP and TNF-α at the fifth day after intestinal obstruction were higher than those at the first day after operation (t =12.762,6.708,6.973,all P ＜0.05).The levels of PCT[(2.13 ±0.48) ng/'mL],CRP [(11.24 ± 2.37) mg/L],TNF-α [(2.16 ± 0.40) ng/L] of the ineffective group were higher than those of the effective group[(1.64 ± 0.31) ng/mL,(8.86 ± 1.65) mg/L,(1.77 ± 0.32) ng/L,t =4.757,4.507,4.052,all P ＜ 0.05].Correlation analysis showed that PCT,CRP and TNF-α levels were closely related to postoperative intestinal obstruction in colorectal cancer patients,and all of them were positively correlated(r =0.892,0.817,0.835,all P ＜ 0.05).Conclusion The levels of PCT,CRP and TNF-αα in the patients with postoperative intestinal obstruction of colorectal cancer are higher than those of the control group.It can predict the occurrence of postoperative intestinal obstruction of colorectal cancer and can be used as a reference index for diagnosis and treatment of postoperative intestinal obstruction in colorectal cancer.%目的 探讨结直肠癌手术后患者血浆降钙素原(PCT)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)水平的变化与其术后肠梗阻的关系.方法 选择大同煤矿集团有限责任公司三医院2014年12月至2017年12月收治且术后发生肠梗阻的结直肠癌手术患者60例与术后未发生肠梗阻的结直肠癌手术患者60例,分别设置为肠梗阻组与非肠梗阻组,所有患者接受血液检查,测定其PCT、CRP、TNF-α,比较肠梗阻组与非肠梗阻组在术前、术后第1天、术后第5天的PCT、CRP、TNF-α水平,并比较术后不同时间点肠梗阻组的PCT、CRP、TNF-α水平.根据肠梗阻组患者术后第5天转归情况将其分为有效组、无效组,比较有效组与无效组的PCT、CRP、TNF-α水平.采用皮尔逊相关性分析法,对PCT、CRP、TNF-α水平与结直肠癌患者手术后发生肠梗阻的相关性进行分析.结果 在术前、术后第1天,肠梗阻组与非肠梗阻组的PCT、CRP、TNF-α水平比较均差异无统计学意义(术前t=0.706、0.459、0.249,术后第1天t=0.874、0.434、1.460,均P＞0.05),而在术后第5天,肠梗阻组的PCT、CRP、TNF-α分别为(1.89±0.53) ng/mL、(10.06±2.50) mg/L、(1.95±0.59) ng/L,均高于非肠梗阻组的(1.05±0.32) ng/mL、(7.27±2.06) mg/L、(1.15 ±0.28) ng/L(t=10.510、6.671、9.489,均P＜0.05).肠梗阻组术后第5天的PCT、CRP、TNF-α水平均高于术后第1天(t=12.762、6.708、6.973,均P＜0.05).无效组的PCT、CRP、TNF-α分别为(2.13 ±0.48) ng/mL、CLRP(11.24 ±2.37) mg/L、TNF-α(2.16±0.40) ng/L,均高于有效组的(1.64 ±0.31) ng/mL、(8.86±1.65) mg/L、(1.77±0.32) ng/L(t=4.757、4.507、4.052,均P＜0.05).经相关性分析,PCT、CRP、TNF-α水平与结直肠癌患者手术后肠梗阻密切相关,均呈正相关(r=0.892、0.817、0.835,均P＜0.05).结论 PCT、CRP、TNF-α在结直肠癌术后肠梗阻患者中普遍增高,可对结直肠癌术后肠梗阻的发生予以预测,可作为结直肠癌手术后肠梗阻的诊断参考指标和治疗指导指标.