目的

分析化疗后的肺癌患者继发肺部感染病原菌耐药性及炎症因子变化。

方法

选取2019 年2 月至2023 年2 月收治我院因化疗住院的肺癌患者157 例为对象。 院内化疗期间继发肺部感染69 例为观察组，未继发肺部感染88 例为对照组。 观察组呼吸道样本测试病原菌种类，分析常见病原菌药敏试验结果，病原菌耐药率。 比较两组炎性因子，包括C 反应蛋白（C reactive protein， CRP）、降钙素原（procalcitonin， PCT）、肿瘤坏死因子-α（tumor necrosis factor， TNF-α）以及白介素6（interleukin-6，IL-6）。

结果

观察组呼吸道样本中共检出病原菌84 株，包括革兰阴性菌52 株（61.91%）、革兰阳性菌26 株（30.95%）、真菌6 株（7.14%）。 革兰氏阴性菌52 株中包含，铜绿假单胞菌26 株、肺炎克雷伯菌15 株、鲍曼不动杆菌10 株，其他1 株；革兰氏阴性菌对头孢曲松、头孢吡肟以及氨苄西林有较高抗药性，对庆大霉素、左氧氟沙星和复方新诺明有一定耐药性，对亚胺培南耐药性较低。 革兰阳性菌26 株中包含，金黄色葡萄球菌15 株、肺炎链球菌7 株、溶血性葡萄球菌4 株。 革兰阳性菌对青霉素、红霉素、克林霉素有较高抗药性，对利奈唑胺和庆大霉素有一定抗药性，对万古霉素和左氧氟沙星耐药率低。 真菌6 株中包含，白色念珠菌5 株、光滑念珠菌1 株。 真菌对氟尿嘧啶耐药率高，对氟康唑、酮康唑和两性霉素B 耐药性较低。 观察组CRP（24.16±5.88）mg/L、PCT（4.21±1.96）ng/ml、TNF-α（25.76±5.34）ng/L 以及IL-6（36.34±2.24）ng/L 高于对照组（11.97±3.55）mg/L、（1.02±0.98）ng/ml、（18.55±4.21）ng/L、（22.68±1.08）ng/L（P＜0.05）。 肺癌化疗患者继发肺部感染影像学影像学表现多变，可出现大片分布的磨玻璃影与局部浸润、增生改变，可累及两个肺野，影像学吸收较慢。

结论

肺癌化疗继发肺部感染患者体内病原菌类型多种，其中革兰氏阴性菌最常见，病原菌对常见抗菌药的耐药性存在差异，患者体内炎症反应增多，可依据药敏结果，结合患者临床症状给予抗菌药物。

Objective

To analyze the changes in pathogen resistance and inflammatory factors in secondary lung infections in lung cancer patients after chemotherapy.

Methods

A total of 157 lung cancer patients admitted to the respiratory department from February 2019 to February 2023 were hospitalized due to chemotherapy were selected as the study subjects. There were a total of 69 patients in the observation group who developed secondary pulmonary infections， and 88 patients in the control group who did not develop secondary pulmonary infections. Respiratory samples from infected patients were sent to be tested for pathogen types.Levels of C-reactive protein（CRP）， procalcitonin（PCT）， tumor necrosis factor-α（TNF-α）and interleukin-6（IL-6） in two groups of patients were compared.

Results

A total of 84 strains of pathogenic bacteria were detected in respiratory samples. Gram-negative bacteria accounted for 61.91%（n=52）， while gram-positive bacteria accounted for 30.95% （n=26）， and fungi accounted for 7.14% （n=6）. There were differences in the resistance of different pathogens to common antibiotics. The 52 strains contained Gram-negative bacteria， 26 Pseudomonas aeruginosa， 15 Klebsiella pneumoniae， 10 Acinetobacter baumannii， and 1 other strain. Gramnegative bacteria showed high resistance to ceftriaxone， cefepime， and ampicillin， certain resistance to gentamicin， levofloxacin， and co-trimoxazole， and low resistance to imipenem.The 26 gram-positive strains，included S. aureus 15 strains ， Streptococcus pneumoniae 7 strains， S. haemolytica 4 strains. Gram-positive strains showed high resistance to penicillin， erythromycin， clindamycin， some resistance to linezolid and gentamicin， and low resistance to vancomycin and levofloxacin. Fungal 6 strains included， C. albicans 5 strains and C. glabrata 1 strain. Fungal strains showed high resistance to fluorouracil and low resistance to fluconazole，ketoconazole， and amphotericin B.In observation group CRP（24.16±5.88）mg/L， PCT（4.21±1.96）ng/ml，TNF-α（25.76±5.34）ng/L， IL-6（36.34±2.24）ng/L higher than control group（11.97±3.55）mg/L， （1.02±0.98）ng/ml， （18.55±4.21）ng/L， （22.68±1.08）ng/L（P＜0.05）. The imaging examination of secondary lung infection in lung cancer chemotherapy patients mostly showed scattered distribution sheet infiltrative changes，which could involve both lung fields， and the imaging absorption was slower.

Conclusions

Pathogens in the body of lung cancer patients with secondary lung infections after chemotherapy are various， with Gram negative bacteria having the highest infection rate. There are differences in resistance to common antibiotics and strong inflammatory reactions. Clinical selection of antibiotics should be based on drug sensitivity results and the actual situation of patients.