■探讨使用肺动态顺应性(Cdyn)和气道阻力(RAW)水平预测接受放疗的老年食管癌患者肺部感染的表现。
■回顾性收集2017年10月至2022年7月在山西汾阳医院接受放疗的298例老年食管癌患者的临床资料。根据患者肺部感染情况分为感染组(124例)和非感染组(174例)。然后,在感染组中,CURB-65评分用于评估患者肺部感染的严重程度,并将患者进一步分为亚组,轻度感染亚组36例,中度感染亚组58例,重度感染亚组30例。Cdyn的水平,RAW,和感染指标,包括血清降钙素原(PCT),白细胞介素-6(IL-6),和血管紧张素Ⅱ(AngⅡ),在两组患者中进行测量,并比较感染组和非感染组以及不同严重程度感染患者之间的差异。Cdyn和RAW与PCT水平的相关性,检测IL-6和AngⅡ。使用受试者工作特征(ROC)曲线评估Cdyn和RAW预测感染的性能。
■感染组患者的Cdyn水平低于非感染组患者,感染组的RAW水平高于非感染组(P<0.05)。在感染亚组中,轻度感染亚组的Cdyn水平高于中度和重度感染亚组,而RAW的水平,PCT,轻度感染亚组的IL-6和AngⅡ低于中重度亚组。中度感染亚组的Cdyn水平高于重度感染亚组。而RAW,PCT,中度感染亚组IL-6、AngⅡ水平低于重度感染亚组,差异均有统计学意义(P<0.05)。肺部感染患者的Cdyn水平与PCT呈负相关。IL-6和AngⅡ水平与感染严重程度(r分别为-0.501、-0.430、-0.367和-0.484,P<0.05),而RAW与PCT呈正相关,IL-6和AngⅡ水平与感染严重程度(r分别为0.483、0.395、0.374和0.423,P<0.05)。Cdyn和RAW预测老年食管癌患者放疗后肺部感染的曲线下面积(AUC)分别为0.898(95%可信区间[CI]:0.857-0.930)和0.823(95%CI:0.775-0.865)。分别,Cdyn和RAW联合评估的AUC为0.959(95%CI:0.930-0.979),这表明联合评估的预测性能优于单独使用Cdyn或RAW的评估。
■老年食管癌患者放疗后出现肺部感染,他们的Cdyn水平降低了,而RAW的水平,PCT,IL-6和AngⅡ升高。此外,Cdyn和RAW的水平与PCT相关,IL-6和AngⅡ水平。联合使用Cdyn和RAW在预测患者肺部感染方面显示出良好的性能。
UNASSIGNED: To investigate the performance of using lung dynamic compliance (Cdyn) and airway resistance (RAW) levels to predict lung infection in elderly esophageal cancer patients who have undergone radiotherapy.
UNASSIGNED: A total of 298 elderly esophageal cancer patients who received radiotherapy at Shanxi Fenyang Hospital between October 2017 and July 2022 were retrospectively enrolled and their clinical data were collected. The patients were divided into an infection group (124 cases) and a non-infection group (174 cases) according to their status of lung infection. Then, in the infection group, CURB-65 score was used to assess the severity of the patients\' lung infection and the patients were further divided into subgroups accordingly, with 36 cases in the mild infection subgroup, 58 cases in the moderate infection subgroup, and 30 cases in the severe infection subgroup. The levels of Cdyn, RAW, and infection indicators, including serum procalcitonin (PCT), interleukin-6 (IL-6), and angiotensin Ⅱ (Ang Ⅱ), were measured in both groups of patients and the differences in the findings were compared between the infection and the non-infection groups and among patients with infection of varying degrees of severity. The correlation between Cdyn and RAW and the levels of PCT, IL-6, and Ang Ⅱ was analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the performance of predicting infection with Cdyn and RAW.
UNASSIGNED: The Cdyn level of patients in the infection group was lower than that of patients in the non-infection group, while the RAW level of the infection group was higher than that of the non-infection group (P<0.05). Among the infection subgroup, the level of Cdyn of the mild infection subgroup was higher than those of the moderate and severe infection subgroups, while the levels of RAW, PCT, IL-6, and Ang Ⅱ of the mild infection subgroup were lower than those of the moderate severe subgroups. The level of Cdyn of the moderate infection subgroup was higher than that of the severe infection subgroup, while the RAW, PCT, IL-6, and Ang Ⅱ levels of the moderate infection subgroup were lower than those of the severe infection subgroup, with all difference being statistically significant (P<0.05). The Cdyn level of patients with lung infection was negatively correlated with PCT, IL-6, and Ang Ⅱ levels and the severity of infection (r=-0.501, -0.430, -0.367, and -0.484, respectively, P<0.05), while RAW was positively correlated with PCT, IL-6, and Ang Ⅱ levels and the severity of infection (r=0.483, 0.395, 0.374, and 0.423, respectively, P<0.05). The area under the curve (AUC) of Cdyn and RAW for predicting lung infection in elderly patients with esophageal cancer after radiotherapy were 0.898 (95% confidence interval [CI]: 0.857-0.930) and 0.823 (95% CI: 0.775-0.865), respectively, and the AUC of combined evaluation of Cdyn and RAW was 0.959 (95% CI: 0.930-0.979), which suggested that the predictive performance of combined evaluation was better than evaluation with Cdyn or RAW alone.
UNASSIGNED: When elderly esophageal cancer patients develop lung infection after radiotherapy, their Cdyn level is decreased, while the levels of RAW, PCT, IL-6, and Ang Ⅱ are increased. In addition, the levels of Cdyn and RAW are correlated with the PCT, IL-6, and Ang Ⅱ levels. The combined use of Cdyn and RAW shows good performance for predicting lung infection in patients.