乳腺癌改良根治术后感染的病原学特征、影响因素及炎症因子分析

doi:10.19401/j.cnki.1007-3639.2025.06.005

摘要/Abstract

摘要：

背景与目的： 乳腺癌改良根治术是治疗乳腺癌的重要方式，但术后切口感染的风险较高，会严重影响患者的治疗效果及预后。本研究旨在探讨乳腺癌改良根治术后切口感染的病原学特征、影响因素及血清炎症因子的变化及意义。方法： 回顾性分析郑州市第三人民医院2019年2月—2022年2月收治的乳腺癌患者的临床资料。患者均行改良乳腺癌根治术，分析术后切口感染的病原菌分布特点、影响因素及血清降钙素原（procalcitonin，PCT）、C反应蛋白（C reactive protein，CRP）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白细胞介素-6（interleukin-6，IL-6）等炎症因子的变化。本研究获郑州市第三人民医院医学伦理委员会审核批准（审批号：2025-04-014-K01）并获得患者知情同意。本病例对照研究严格遵循《加强流行病学中观察性研究报告质量》（Strengthening the Reporting of Observational Studies in Epidemiology，STROBE）指南中的各项条目。结果： 共128例乳腺癌患者纳入本研究，根据术后是否发生切口感染分为感染组（22例）和非感染组（106例）。乳腺癌改良根治术后切口感染率为17.19%（22/128），22例术后切口感染的患者共分离培养病原菌26株，其中革兰氏阳性菌16株，占61.54%（16/26），以金黄色葡萄球菌、粪肠球菌为主；革兰氏阴性菌10株，占38.46%（10/26），以大肠埃希菌、铜绿假单胞菌为主。乳腺癌改良根治术后切口感染的影响因素包括术前行新辅助化疗、术中出血量≥300 mL、术后引流量≥800 mL、留置引流管时间≥7 d、白蛋白<35 g/L、白细胞计数<4×10⁹/L（P<0.05）。多因素Logistic回归分析发现，术前行新辅助化疗、出血量≥300 mL、术后引流量≥800 mL、留置引流管时间≥7 d、白蛋白<35 g/L、白细胞计数<4×10⁹/L是改良乳腺癌根治术后切口感染的影响因素（P<0.05）。两组患者外周血PCT、CRP、TNF-α、IL-6水平与术前比较均升高，且感染组高于非感染组（P<0.05）。结论： 乳腺癌改良根治术后切口感染较为常见，病原菌以金黄色葡萄球菌和大肠埃希菌为主，病原菌的耐药性分析可为术后感染的抗菌药物选择提供重要的参考依据；术前行新辅助化疗、出血量≥300 mL、术后引流量≥800 mL、留置引流管时间≥7 d、白蛋白<35 g/ L、白细胞计数<4×10⁹/L是术后感染的独立影响因素，血清PCT、CRP、TNF-α、IL-6的水平可作为预测术后切口感染的有效指标，识别这些危险因素可为临床上采取有效的预防措施提供明确的指导。

关键词: 乳腺癌改良根治术, 切口感染, 病原学, 危险因素, 炎症因子

Abstract:

Background and purpose: Modified radical mastectomy is an important approach for treating breast cancer, but the risk of postoperative incision infection rate is relatively high, which can seriously affect the treatment outcome and prognosis of these patients. This study aimed to investigate the etiological characteristics, related risk factors and changes of serum inflammatory factors such as procalcitonin (PCT), C reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in patients undergoing modified radical mastectomy. Methods: The clinical data of breast cancer patients admitted to the Third People's Hospital of Zhengzhou from February 2019 to February 2022 were analyzed retrospectively. The pathogenic bacteria distribution and related risk factors of postoperative incision infection and the changes of serum inflammatory factors such as PCT, CRP, TNF-α and IL-6 were explored. This study has been approved by the Medical Ethics Committee of the Third People's Hospital of Zhengzhou (No.: 2025-04-014-K01) and acquired the informed consent. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was followed for this case control study. Results: A total of 128 patients were enrolled in this study. All patients underwent modified radical mastectomy were divided into infected group (n=22) and non-infected group (n=106) according to whether incision infection occurred after surgery. The incision infection rate after modified radical mastectomy was 17.19% (22/128). Twenty-six strains of pathogenic bacteria were isolated and cultured from 22 patients with postoperative incision infection. Among these, 16 strains were Gram-positive, accounting for 61.54% (16/26), mainly staphylococcus aureus and enterococcus faecalis. There were 10 Gram-negative strains, accounting for 38.46% (10/26), mainly escherichia coli and pseudomonas aeruginosa. The influencing factors of incision infection after modified radical mastectomy included preoperative neoadjuvant chemotherapy, intraoperative blood loss ≥300 mL, postoperative drainage volume ≥800 mL, drainage time ≥7 d, albumin <35 g/L, and white blood cell count <4×10⁹/L (P<0.05). Multivariate logistic regression analysis showed that preoperative neoadjuvant chemotherapy, blood loss ≥300 mL, postoperative drainage volume ≥800 mL, duration of drainage time ≥7 d, albumin <35 g/L and white blood cell count <4×10⁹/L were the independent influencing factors of incision infection after modified radical mastectomy (P<0.05). The peripheral blood levels of PCT, CRP, TNF-α and IL-6 in both groups increased compared with those before surgery, and those in the infected group were higher than those in the non-infected group (P<0.05). Conclusion: staphylococcus aureus and escherichia coli were the main pathogens after modified radical breast mastectomy. Preoperative neoadjuvant chemotherapy, blood loss ≥300 mL, postoperative drainage volume ≥800 mL, drainage time ≥7 d, albumin <35 g/L and white blood cell count <4×10⁹/L were the independent influencing factors. The levels of serum PCT, CRP, TNF-α and IL-6 could be used as effective indicators to predict postoperative incision infection.

Key words: Modified radical mastectomy, Incision infection, Etiology, Risk factors, Inflammatory factor

中图分类号:

R737.9

钱芳, 孙永强, 张思涵, 宋田利. 乳腺癌改良根治术后感染的病原学特征、影响因素及炎症因子分析[J]. 中国癌症杂志, 2025, 35(6): 563-569.

QIAN Fang, SUN Yongqiang, ZHANG Sihan, SONG Tianli. Analysis of etiological characteristics, risk factors and inflammatory factors in patients with postoperative infection following modified radical mastectomy[J]. China Oncology, 2025, 35(6): 563-569.

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Pathogenic bacteria	Bacterial numbers (n=26)
Staphylococcus aureus	8 (30.77)
Enterococcus faecalis	3 (11.54)
Staphylococcus epidermidis	2 (7.69)
Staphylococcus haemolyticus	2 (7.69)
Streptococcus	1 (3.85)
E. coli	4 (15.38)
Pseudomonas aeruginosa	3 (11.54)
Klebsiella pneumoniae	1 (3.85)
Acinetobacter baumannii	1 (3.85)
Enterobacter cloacae	1 (3.85)

Antibiotics	Staphylococcus aureus	Enterococcus faecalis
Penicillin	7 (87.50)	3 (100.00)
Ceftriaxone	6 (75.00)	0 (0.00)
Gentamicin	1 (12.50)	2 (66.67)
Clindamycin	1 (12.50)	0 (0.00)
Levofloxacin	3 (37.50)	1 (33.33)
Tetracycline	2 (25.00)	0 (0.00)
Rifampicin	1 (12.50)	0 (0.00)
Oxacillin	1 (12.50)	0 (0.00)
Vancomycin	0 (0.00)	0 (0.00)
Erythromycin	1 (12.50)	0 (0.00)

Antibiotics	E. coli	Pseudomonas aeruginosa
Penicillin	4 (100.00)	3 (100.00)
Ceftazidime	3 (75.00)	3 (100.00)
Amikacin	0 (0.00)	0 (0.00)
Gentamicin	2 (50.00)	2 (66.67)
Meropenem	0 (0.00)	0 (0.00)
Rifampicin	0 (0.00)	0 (0.00)
Levofloxacin	1 (25.00)	1 (33.33)
Tobramycin	0 (0.00)	0 (0.00)
Lincomycin	0 (0.00)	0 (0.00)
Azithromycin	0 (0.00)	1 (33.33)

Factors	Case n	infection	Non-infection	χ² value	P value
Age/year				0.196	0.658
≥45	82	15(18.29)	67(81.71)
<45	46	7(15.22)	39(84.78)
BMI/(kg·m^-2)				2.974	0.085
≥25	49	12(24.49)	37(75.51)
<25	79	10(12.66)	69(87.34)
Comorbidity				1.856	0.603
Hypertension	20	5(25.00)	15(75.00)
Diabetes	12	3(25.00)	9(75.00)
COPD	8	1(12.50)	7(87.50)
No	88	13(14.77)	75(85.23)
TNM stage				0.603	0.437
Ⅰ	0	0(0.00)	0(0.00)
Ⅱ	62	9(14.52)	53(85.48)
Ⅲ	66	13(19.70)	53(80.30)
Ⅳ	0	0(0.00)	0(0.00)
Pre-NC				9.585	0.0021
Yes	40	13(43.33)	27(67.50)
No	88	9(10.23)	79(89.77)
ASA grade				2.916	0.233
Ⅰ	26	7(26.92)	19(73.08)
Ⅱ	64	11(17.19)	53(82.81)
Ⅲ	38	4(10.53)	34(89.47)
Surgery time t/min				1.179	0.278
≥120	68	14(20.59)	54(79.41)
<120	60	8(13.33)	52(86.67)
Blood loss V/mL				11.997	<0.01
≥300	46	15(32.61)	31(67.39)
<300	82	7(8.54)	75(91.46)
Drainage V/mL				29.024	<0.01
≥800	34	16(47.06)	18(52.94)
<800	94	6(6.38)	88(93.62)
Drain time t/d				10.951	<0.01
≥7	58	17(29.31)	41(70.69)
<7	70	5(7.14)	65(92.86)
Albumin/(g·L^-1)				7.584	0.006
≥35	69	6(13.04)	63(91.30)
<35	59	16(22.03)	43(72.88)
WBC/L				4.269	0.039
≥4×10⁹	72	8(13.89)	64(88.89)
<4×10⁹	56	14(21.43)	42(75.00)

Factors	β	S.E.	Wald χ²	OR	95% CI	P value
Pre-NC	1.614	0.388	17.266	5.021	2.345-10.747	<0.01
Blood loss≥300 mL	1.876	0.392	22.871	6.525	3.025-14.075	<0.01
Drainage≥800 mL	2.758	0.430	41.121	15.769	6.787-36.635	<0.01
Drain time≥7 d	1.998	0.421	23.575	7.376	3.292-16.523	<0.01
Albumin<35 g/L	1.363	0.475	8.239	0.256	0.101-0.649	<0.01
WBC<4×10⁹/L	0.773	0.404	3.668	0.462	0.209-1.018	0.035