【摘要】 目的 探讨食管癌开胸术患者术后肺部感染对RAAS的影响及可能机制分析。方法 选取2018年1月至2020年6月天津海滨人民医院收治的食管癌并行开胸术治疗患者120例。按术后是否合并感染分为感染组（46例）和未感染组（74例）。并按感染严重程度将感染组分为轻度组（12例）、中度组（26例）和重度组（8例）。分别于手术前后测定入组患者RAAS系统[血管紧张素Ⅱ（Ang-Ⅱ）、醛固酮（ALD）和肾素（NE）]表达及术后3d营养水平（总蛋白和白蛋白）、免疫功能及血清指标[B型利钠肽（BNP）、N末端前体脑利钠肽（NT-proBNP）]并记录术后1周感染组心衰发生情况。结果 术前两组血清Ang-Ⅱ、ALD和NE水平比较差异没有统计学意义（P>0.05）；术后3d感染组血清Ang-Ⅱ、ALD和NE水平均显著高于未感染组（P<0.05）；重度组患者血清Ang-Ⅱ、ALD、NE、BNP、TNF-α、IL-6、NT-proBNP水平及心力衰竭发生率显著高于中度及轻度组，而CD4~+、CD8~+、CD4~+/CD8~+、总蛋白和白蛋白水平显著低于中度及轻度组（P<0.05）。结论 食管癌行开胸术治疗患者术后合并肺部感染可对RAAS系统产生影响，其可能机制为肺部感染后加重对患者免疫功能、营养水平的影响，低营养及免疫水平更有利于肺部炎症的持续激活，而持续的高炎症反应加重对心肌功能的损伤，进而表现为RAAS系统表达紊乱。更多还原

【Abstract】 Objective To investigate the influence of postoperative lung infection on RAAS in patients undergoing thoracotomy for esophageal cancer and its possible mechanism.Methods A total of 120patients with esophageal cancer and thoracotomy who were admitted to our hospital from January 2018to June 2020were selected.They were divided into infected group(46cases)and non-infected group(74cases)according to whether they were co-infected.According to the severity of infection,the infection group was divided into mild group(12cases),moderate group(26cases)and severe group(8cases).The RAAS system[angiotensinⅡ（Ang-Ⅱ）,aldosterone(ALD)and renin(NE)]expression and3dpostoperative nutritional level(total protein and albumin),immune function and Serum indicators[B-type natriuretic peptide(BNP),N-terminal precursor brain natriuretic peptide(NT-proBNP)]and record the occurrence of heart failure in the infection group one week after surgery.Results The serum Ang-Ⅱ,ALD and NE levels of the two groups before operation were compared(P>0.05);the serum Ang-Ⅱ,ALD and NE levels of the infected group were significantly higher than those of the non-infected group at 3days postoperatively(P<0.05);The incidence of serum Ang-Ⅱ,ALD,NE,BNP,TNF-α,IL-6,NT-proBNP and heart failure in the severe group was significantly higher than that in the moderate and mild groups,while CD4~+,CD8~+,CD4~+/CD8~+,total protein and albumin levels were significantly lower than the moderate and mild groups(P<0.05).Conclusion Patients with esophageal cancer undergoing thoracotomy for postoperative pulmonary infection can have an impact on the RAAS system.The possible mechanism is the aggravated effect of lung infection on the patient’s immune function and nutritional level.Low nutrition and immune level are more beneficial the continuous activation of lung inflammation,and the continuous high inflammatory response aggravates the damage to myocardial function,which in turn manifests as a disorder of RAAS system expression.更多还原