血清白细胞介素-17和可溶性血红蛋白清道夫受体163对结直肠癌患者腹腔镜术后发生早期吻合口瘘的预测价值

Predictive value of serum IL-17 and sCD163 for early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery

摘要:

目的 探讨血清白细胞介素-17（IL-17）和可溶性血红蛋白清道夫受体163（sCD163）对结直肠癌患者腹腔镜术后发生早期吻合口瘘的预测价值。方法 选取2022年6月－2024年6月该院收治的80例行腹腔镜手术的结直肠癌患者作为研究对象，根据患者术后7 d内是否发生吻合口瘘，将患者分为吻合口瘘组（17例）和非吻合口瘘组（63例）。酶联免疫吸附测定（ELISA）检测患者术前1 d、术后1 d、术后3 d、术后5 d和术后7 d的血清IL-17和sCD163水平，比较两组患者临床资料。采用多因素Logistic回归模型，分析影响结直肠癌患者腹腔镜术后发生早期吻合口瘘的独立危险因素；采用受试者操作特征曲线（ROC curve），分析血清IL-17和sCD163水平对结直肠癌患者腹腔镜术后发生早期吻合口瘘的预测价值。结果 吻合口瘘组肿瘤距肛门距离 < 7 cm占比高于非吻合口瘘组，术后7 d引流量多于非吻合口瘘组，差异均有统计学意义（P < 0.05）；两组患者不同时点血清IL-17和sCD163水平组间、时间和交互效应比较，差异均有统计学意义（P < 0.05）；多因素Logistic回归分析结果显示：肿瘤距肛门距离 < 7 cm（OR＾ = 3.176，95%CI：1.128～8.940）、术后3 d血清IL-17水平 ≥ 43.95 pg/mL（OR＾ = 2.145，95%CI：1.281～3.592）和术后5 d血清sCD163水平 ≥ 81.02 pg/mL（OR＾ = 1.852，95%CI：1.225～2.801）是结直肠癌患者腹腔镜术后发生早期吻合口瘘的独立危险因素（P < 0.05）；血清IL-17和sCD163两者联合，预测结直肠癌患者腹腔镜术后发生早期吻合口瘘的曲线下面积（AUC）为0.923，两者联合诊断效能优于血清IL-17或sCD163单一诊断（Z_{两者联合-IL-17} = 2.77、Z_{两者联合-sCD163} = 2.11，P < 0.05）。结论 结直肠癌腹腔镜术后发生早期吻合口瘘的患者，血清IL-17和sCD163水平会升高，两者联合检测，对预测结直肠癌患者腹腔镜术后早期吻合口瘘的发生风险，有一定的临床价值。

Abstract:

Objective To investigate the predictive value of serum interleukin-17 (IL-17) and soluble hemoglobin scavenger receptor 163 (sCD163) for early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery.Methods From June 2022 to June 2024, 80 colorectal cancer patients who underwent laparoscopic surgery were selected as the study subjects. Patients were subdivided into an anastomotic leakage group (17 cases) and a non-anastomotic leakage group (63 cases) according to whether an anastomotic leakage occurred within 7 d postoperatively. Enzyme-linked immunosorbent assay (ELISA) was applied to detect the levels of serum IL-17 and sCD163 in patients on preoperative day 1, postoperative day 1, postoperative day 3, postoperative day 5, and postoperative day 7. The clinical data of the two groups were compared. Multivariate Logistic regression was applied to analyze the influencing factors of early anastomotic leakage in colorectal cancer patients after laparoscopic surgery. The receiver operating characteristic curve (ROC curve) was applied to analyze the predictive value of serum IL-17 and sCD163 levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results The percentage of distance between tumor and anus < 7 cm was higher in the anastomotic leakage group than that in the non-anastomotic leakage group, and the amount of drainage was more than that in the non-anastomotic leakage group at 7 d postoperatively, the differences were statistically significant (P < 0.05). There were statistically significant differences in the levels of serum IL-17 and sCD163 between the two groups of patients at different time points, as well as in time and interaction effects (P < 0.05). Distance between tumor and anus <7 cm (OR＾ = 3.176, 95%CI: 1.128 ~ 8.940), serum IL-17 level ≥ 43.95 pg/mL at 3 d postoperatively （OR＾ = 2.145, 95%CI: 1.281 ~ 3.592), and serum sCD163 level ≥ 81.02 pg/mL at 5 d postoperatively (OR＾ = 1.852, 95%CI: 1.225 ~ 2.801) were the risk factors of early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery (P < 0.05). The area under the curve (AUC) of the combination of serum IL-17 and sCD163 in predicting early anastomotic leakage in colorectal cancer patients after laparoscopic surgery was 0.923, which was superior to the single diagnosis of serum IL-17 and sCD163 (Z_{combination-IL-17} = 2.77, Z_{combination-sCD163} = 2.11, P < 0.05).Conclusion Serum IL-17 and sCD163 levels are elevated in colorectal cancer patients with early anastomotic leakage after laparoscopic surgery. The combined detection of the two has certain clinical value in predicting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery.