[1]刘宗志,霍承瑜,牛 磊.肺癌术后患者血清ACE2 和CD40L 水平表达与感染程度及致病菌类属的鉴别价值[J].现代检验医学杂志,2023,38(03):128-133+175.[doi:10.3969/j.issn.1671-7414.2023.03.023]
　LIU Zong-zhi,HUO Cheng-yu,NIU Lei.Expression of ACE2 and CD40L in Serum of Patients with Lung Cancer after Operation and the Value of Differential Diagnosis between the Degree of Infection and the Genus of Pathogenic Bacteria[J].Journal of Modern Laboratory Medicine,2023,38(03):128-133+175.[doi:10.3969/j.issn.1671-7414.2023.03.023]
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肺癌术后患者血清ACE2 和CD40L 水平表达与感染程度及致病菌类属的鉴别价值()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年03期
页码:
128-133+175
栏目:
论著
出版日期:
2023-05-15

文章信息/Info

Title:
Expression of ACE2 and CD40L in Serum of Patients with Lung Cancer after Operation and the Value of Differential Diagnosis between the Degree of Infection and the Genus of Pathogenic Bacteria
文章编号:
1671-7414（2023）03-128-07
作者:
刘宗志; 霍承瑜; 牛 磊
（民航总医院心胸外科，北京 100123）
Author(s):
LIU Zong-zhi;  HUO Cheng-yu;  NIU Lei
（Department of Cardiothoracic Surgery, General Hospital of Civil Aviation, Beijing 100123, China）
关键词:
肺癌; 术后感染; 血管紧张素转换酶2; CD40 配体; 病原菌分布
分类号:
R734.2；R730.43
DOI:
10.3969/j.issn.1671-7414.2023.03.023
文献标志码:
A
摘要:
目的 探讨肺癌术后感染患者血管紧张素转换酶2（ACE2）和CD40 配体（CD40L）与感染程度的关系及对致病菌类属的鉴别价值，为临床早期经验用药提供参考。方法 选取民航总医院2017 年1 月～ 2021 年12 月经手术治疗的肺癌患者1 186 例作为研究对象。统计术后感染发生情况（感染率、严重程度、病原菌类型），比较不同感染程度、不同致病菌类属患者ACE2 及CD40L 水平，Spearman 分析ACE2 及CD40L 水平与感染程度的相关性，受试者工作特征（ROC）曲线分析ACE2 和CD40L 对致病菌类属的鉴别价值。结果 1 186 例肺癌患者术后感染率为6.75%（80/1 186），其中轻度感染26 例，中度感染35 例和重度感染19 例。分离病原菌93 株，其中革兰阴性菌（G－）67 株，革兰阳性菌（G＋）26 株；与肺癌术后未感染患者比较，术后感染患者血清ACE2（73.99±16.18 U/L vs 49.42±10.33 U/L）和CD40L（30.91±5.91 μg/L vs 21.67±5.02 μg/L）水平升高，差异具有统计学意义（t=17.833， 14.321，均P ＜ 0.001）；随着感染程度加重血清ACE2（67.77±7.53 U/L，74.49±12.57 U/L，81.60±9.63 U/L）和CD40L（28.27±3.76 μg/L，31.42±4.83 μg/L，33.45±3.41 μg/L）水平均呈上升趋势，差异具有统计学意义（F=5.534，13.746，均P ＜ 0.001）；血清ACE2，CD40L 水平与肺癌患者术后感染程度均呈正相关关系（r=0.835，0.710，均P ＜ 0.001）；G－菌感染患者血清ACE2（74.56±5.57U/L） 及CD40L 水平（31.08±2.72μg/L） 高于G ＋ 菌感染患者（68.05±4.76U/L，28.33±2.47μg/L），差异具有统计学意义（t=2.479，2.309，均P ＜ 0.05）；ACE2（OR=2.627，95%CI：1.268 ～ 5.443，P=0.001）和CD40L（OR=3.628，95%CI：1.752 ～ 6.097，P ＜ 0.001）水平升高是肺癌患者术后存在G－感染的独立危险因素；ACE2 联合CD40L 鉴别肺癌患者术后感染病原菌类型的AUC，敏感度和特异度分别为0.935，87.50% 和90.48%。结论 肺癌患者术后ACE2 和CD40L 高表达，且与感染严重程度存在正相关关系，检测ACE2 和CD40L 对鉴别肺癌术后感染病原菌类型有重要价值，可指导临床早期经验用药。
Abstract:
Objective To explore the relationship between angiotensin-converting enzyme 2 (ACE2) and CD40 ligand (CD40L) and the degree of infection in patients with postoperative infection of lung cancer and the value of differential diagnosis of pathogenic bacteria, so as to provide reference for early clinical experience in drug use. Methods A total of 1 186 patients with lung cancer who underwent surgical treatment from January 2017 to December 2021 were selected, and all of them underwent surgery. The incidence of postoperative infection (infection rate, severity and pathogen type) was counted, and the levels of ACE2 and CD40L in patients with different infection degrees and pathogen types were compared.The correlation between the levels of ACE2 and CD40L and the degree of infection was analyzed, and receiver operating characteristic (ROC) curve was used to analyze the value of ACE2 and CD40L in differentiating pathogen genus of pathogenic bacterias. Results The postoperative infection rate of 1 186 lung cancer patients was 6.75% (80/1 186), among with 26 cases of mild infection, 35 cases of moderate infection, and 19 cases of severe infection. 93 strains of pathogenic bacteria were isolated including 67 strains of Gram-negative bacteria (G-), 26 strains of Gram-positive bacteria (G+).The serum levels of ACE2 (73.99±16.18 U/L vs 49.42±10.33 U/L) and CD40L (30.91±5.91μg/L vs 21.67±5.02μg/L) in patients with infection after lung cancer surgery were higher than those in patients without infection, the differences were statistically significant(t=17.833, 14.321, all P ＜ 0.001). Serum ACE2 (67.77±7.53, 74.49±12.57 and 81.60±9.63 U/L） and CD40L (28.27±3.76, 31.42±4.83 and 33.45±3.41μg/L) levels increased with the severity of infection (F=5.534, 13.746, P ＜ 0.001). Serum ACE2 and CD40L levels were positively correlated with postoperative infection degree in patients with lung cancer (r=0.835, 0.710, all P ＜ 0.001).The serum levels of ACE2 (74.56±5.57U/L) and CD40L (31.08±2.72μg/L) in patients with G- infection were higher than those in patients with G+ infection (68.05±4.76U/L), (28.33±2.47μg/L), and the severity of infection was more severe than that in patients with G+ infection, the differences were statistically significant (t=2.479, 2.309, all P ＜ 0.05). Elevated levels of ACE2 (OR=2.627, 95% CI: 1.268 ～ 5.443, P=0.001) and CD40L (OR=3.628, 95% CI: 1.752 ～ 6.097, P<0.001) were independent risk factors for postoperative G- infection in patients with lung cancer. The AUC, sensitivity and specificity of ACE2 and CD40L combined to identify the types of pathogenic bacteria in patients with lung cancer after surgery were 0.935, 87.50% and 90.48%, respectively. Conclusion Postoperative infection in patients with lung cancer promotes high expression of ACE2 and CD40L, and there was a positive correlation with the severity of infection. Detection of ACE2 and CD40L is of great value in identifying the types of pathogenic bacteria infected after lung cancer surgery, and it can guide early clinical experience and medication.

参考文献/References:

[1] 中国肺癌防治联盟, 中华医学会呼吸病学分会肺癌 学组, 中国医师协会呼吸医师分会肺癌工作委员 会. 肺癌筛查与管理中国专家共识[J]. 国际呼吸杂 志,2019,39(21):1604-1615. Chinese Alliance Against Lung Cancer, Chinese Medical Association of Respiratory Disease Branch Lung Cancer Study Group, Chinese Medical Doctor Association of Respiratory Doctor Branch Lung Cancer Working Committee. Chinese expert consensus on screening and management of lung cancer[J]. International Journal of Respiration , 2019, 39(21): 1604-1615.
[2] DA SILVA FILHA R, SERGIO VELOSO BRANT P, E. CORDEIRO T M, et al. Evidence for a role of angiotensin converting enzyme 2 in proteinuria of idiopathic nephrotic syndrome[J]. Bioscience Reports,2019, 39(1): BSR20181361.
[3] STEVEN S, DIB M, HAUSDING M, et al. CD40L controls obesity-associated vascular inflammation,oxidative stress, and endothelial dysfunction in high fat diet-treated and db/db mice[J]. Cardiovascular Research, 2018, 114(2): 312-323.
[4] 马宏境, 黄少祥, 刘彬, 等. 胸腔镜引导下行肺癌根 治术后感染患者血清急性时相反应蛋白研究[J]. 中 华医院感染学杂志,2019,29(11):1677-1681. MA Hongjing, HUANG Shaoxiang, LIU Bing, et al. Postoperative infection in patients undergoing thoracoscopy-guided radical resection of lung cancer and acute phase reaction proteins in serum[J]. Chinese Journal of Nosocomiology, 2019, 29(11): 1677-1681.
[5] 王丽萍, 孙常铭, 张日, 等. 肺癌患者围手术期感染 血清炎症因子与N 末端脑钠肽前体水平变化及临床 意义[J]. 中华医院感染学杂志, 2020, 30(2):220-223. WANG Liping, SUN Changming, ZHANG Ri,et al. Changes of serum inflammatory factors and N-terminal pro-brain natriuretic peptide of lung cancer patients with perioperative infection and their clinical significance[J]. Chinese Journal of Nosocomiology ,2020, 30(2): 220-223.
[6] 支修益, 石远凯, 于金明. 中国原发性肺癌诊疗规范 (2015 年版)[J]. 中华肿瘤杂志,2015,37(1):67-78. ZHI Xiuyi, SHI Yuankai, YU Jinming. Standards for the diagnosis and treatment of primary lung cancer (2015 version) in China[J]. Chinese Journal of Oncology,2015, 37(1): 67-78.
[7] 中华医学会呼吸病学分会. 肺部感染性疾病支气管 肺泡灌洗病原体检测中国专家共识(2017 年版)[J]. 中华结核和呼吸杂志, 2017, 40(8):578-583. Chinese Thoracic Society. Consensus of Chinese experts on detection of bronchoalveolar lavage pathogens in pulmonary infectious diseases(2017 Edition)[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2017, 40(8): 578-583.
[8] LUYT C E, CHASTRE J, FAGON J Y. Value of the clinical pulmonary infection score for the identification and management of ventilator-associated pneumonia[J]. Intensive Care Medicine, 2004, 30(5): 844-852.
[9] 马颖欣, 张国平, 乔安邦, 等. 老年肺癌患者术后发 生院内肺部感染的病原菌分布及多重耐药性分析 [J]. 传染病信息,2020,33(2):147-150. MA Yingxin, ZHANG Guoping, QIAO Anbang, et al. Distribution of pathogenic bacteria and multi-drug resistance in postoperative nosocomial lung infection in senile patients with lung cancer[J]. Infectious Disease Information, 2020, 33(2): 147-150.
[10] 呼爱鲜. 肺癌患者肺切除术后肺部感染危险因素分 析[J]. 新乡医学院学报, 2022, 39(2):160-164． HU Aixian. Risk factors for pulmonary infection in patients with lung cancer after pulmonary resection[J]. Journal of Xinxiang Medical University, 2022, 39(2): 160-164.
[11] ZHANG Qi, LU Sihong, LI Tianfu, et al. ACE2 inhibits breast cancer angiogenesis via suppressing the VEGFa/ VEGFR2/ERK pathway[J]. Journal of Experimental & Clinical Cancer Research, 2019, 38(1): 173.
[12] SAMAD A, JAFAR T, RAFI J H. Identification of angiotensin-converting enzyme 2 (ACE2) protein as the potential biomarker in SARS-CoV-2 infectionrelated lung cancer using computational analyses[J]. Genomics, 2020, 112(6): 4912-4923.
[13] 龚晶婧, 李荣通, 卢卓强, 等. ACE2 小干扰RNA 对 平滑肌细胞AT1 受体蛋白表达及其下游信号通路的 影响[J]. 中国药理学通报,2020,36(3):354-359. GONG Jingjing, LI Rongtong, LU Zhuoqiang, et al. Expression of AT1 receptor protein and its downstream signaling pathways in vascular smooth muscle cells after ACE2 siRNA interference[J]. Chinese Pharmacological Bulletin, 2020, 36(3): 354-359.
[14] OGATA Y, NEMOTO W, YAMAGATA R, et al. Anti-hypersensitive effect of angiotensin (1-7) on streptozotocin-induced diabetic neuropathic pain in mice[J]. European Journal of Pain, 2019, 23(4): 739- 749.
[15] 唐国英, 张连花. 儿童细菌性肺炎患儿血清CD40L,VCAM-1 表达变化与其疾病严重程度相关关系研究 [J]. 临床肺科杂志, 2019, 24(5): 827-831. TANG Guoying, ZHANG Lianhua. Study on the relationship between the changes of serum CD40L and VCAM-1 expression and severity of illness in children with bacterial pneumonia in children[J]. Journal of Clinical Pulmonary Medicine, 2019, 24(5): 827-831.
[16] 全守东, 乐原, 杜振元, 等. 肺炎支原体感染哮喘患 儿血清CD40L 和VCAM-1 水平及意义[J]. 中华医 院感染学杂志, 2020, 30(22):3474-3478. QUAN Shoudong, YUE Yuan, DU Zhenyuan, et al. Significance of serum CD40L and VCAM-1 levels in children with asthma infected by Mycoplasma pneumoniae[J]. Chinese Journal of Nosocomiology,2020, 30(22): 3474-3478.
[17] PAN Yanyun, YANG Jinxiu, XU Yifei, et al. Yin yang- 1 suppresses CD40 ligand-CD40 signaling-mediated anti-inflammatory cytokine interleukin-10 expression in pulmonary adventitial fibroblasts by promoting histone H3 tri-methylation at lysine 27 modification on interleukin-10 promoter[J]. Cell Biology International,2020, 44(7): 1544-1555.
[18] BAE J, SAMUR M, RICHARDSON P, et al. Selective targeting of multiple myeloma by B cell maturation antigen (BCMA)-specific central memory CD8+ cytotoxic T lymphocytes: immunotherapeutic application in vaccination and adoptive immunotherapy[J]. Leukemia,2019, 33(9): 2208-2226.
[19] DONG Yuhang, MA Tiejun, ZHANG Xiaoxiao, et al. Incorporation of CD40 ligand or granulocytemacrophage colony stimulating factor into Hantaan virus (HTNV) virus-like particles significantly enhances the long-term immunity potency against HTNV infection[J]. Journal of Medical Microbiology,2019, 68(3): 480-492.
[20] SUN Mengyao, BAI Yang, ZHAO Song, et al. Gramnegative bacteria facilitate tumor progression through TLR4/IL-33 pathway in patients with non-small-cell lung cancer[J]. Oncotarget, 2018, 9(17): 13462-13473.
[21] SKJESOL A, YURCHENKO M, B?SL K, et al. The TLR4 adaptor TRAM controls the phagocytosis of Gram-negative bacteria by interacting with the Rab11- family interacting protein 2[J]. PLoS Pathogens, 2019,15(3): e1007684.
[22] 卢秋维, 廖美娟, 林雪珍.5 种炎性指标对革兰阴性 菌和革兰阳性菌所致脓毒症的早期诊断及鉴别诊断 价值比较[J]. 山东医药,2019,59(17):79-82. LU Qiuwei, LIAO Meijuan, LIN Xuezhen. Comparison of five inflammatory markers in early diagnosis and differential diagnosis of sepsis caused by Gramnegative and Gram-positive bacteria[J]. Shandong Medical Journal, 2019, 59(17): 79-82.
[23] 秦云．肺炎患者血液PLT,PA/Fig 和NGAL 联合检 测在不同类型病原菌感染鉴别及疗效评估中的价值 [J]. 现代检验医学杂志, 2021, 36(5): 83-89. QIN Yun. Value of combined detection of PLT, PA/Fig and NGAL in the blood of patients with pneumonia in the identification of different types of pathogenic infections and the evaluation of therapeutic effects[J]. Journal of Modern Laboratory Medicine, 2021, 36(5): 83-89.

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备注/Memo

备注/Memo:
基金名称：北京市卫生健康委员会2020-3-2202。
作者简介： 刘宗志 （1980-），男，大学本科，硕士学位，副主任医师 ，研究方向：危重胸部创伤的救治、早期肺癌的诊断和治疗、晚期肺癌的综合治疗，E-mail：liuzongzhi1980@aliyun.com。
更新日期/Last Update: 2023-05-15