| 未成熟粒细胞计数预测脊柱手术术后早期感染的应用价值 |
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Received:February 19, 2019
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| 作者 | Author | 单位 | Unit | E-Mail |
| 吴瑞丽 |
WU Rui-li |
运城市中心医院创伤骨科, 山西 运城 044000 |
Department of Trauma and Orthopaedics, Yuncheng Central Hospital, Yuncheng 044000, Shanxi, China |
wuruili1980@163.com |
| 李小斌 |
LI Xiao-bin |
运城市中心医院创伤骨科, 山西 运城 044000 |
Department of Trauma and Orthopaedics, Yuncheng Central Hospital, Yuncheng 044000, Shanxi, China |
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| 王斌 |
WANG Bin |
运城市中心医院神经内科, 山西 运城 044000 |
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| 廉莉 |
LIAN Li |
运城市中心医院乳腺外科, 山西 运城 044000 |
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| 期刊信息：《中国骨伤》2019年32卷，第10期，第898-903页 |
| DOI：10.3969/j.issn.1003-0034.2019.10.005 |
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目的：评估未成熟粒细胞在脊柱手术术后感染的早期预测价值。
方法：收集2016年10月至2018年10月期间收治的78例脊柱手术患者的临床资料，其中男57例，女21例；年龄45～63（55.2±6.1）岁，最常见的损伤病因是脊柱外伤或退行性变。按美国脊髓损伤协会（ASIA）脊髓损伤分级，完全损伤为37例（A级和B级），不完全损伤为41例（C级和D级）。78例患者均表现为不同程度的肢体深浅感觉障碍，均在入院后完善相应椎体节段的CT及MRI检查，根据患者术后1周内是否发生继发性感染分为感染组和未感染组。测量入院时及术后1、3、6 d的IG#（未成熟粒细胞绝对值），IG%（未成熟粒细胞百分比），CRP，PCT，IL-1β，IL-6，TNF-α等指标，运用ROC曲线比较IG%、IG#、PCT在早期判断术后感染的预测价值，使用Spearman相关性检验分析IG%、IG#与PCT的相关性。
结果：术后1周33例发生感染，45例未发生感染。出院时未发生严重并发症及死亡病例，感染组完全性损伤的比例显著高于未感染组（P=0.046），并且感染组损伤部位多为颈胸椎，未感染组多为腰椎损伤（P=0.044）。术后1 d，PCT、IG%、IG#感染组分别为（0.71±0.10）ng/ml、1.08±0.10、0.20±0.05，末未感染组为（0.51±0.08）ng/ml、0.82±0.13、0.13±0.04，两组差异有统计学意义（P<0.001）；术后3 d，CRP、PCT、IL-6、IL-1β、TNF-α、IG#、IG%感染组为（80.47±15.74）mg/L、（2.39±0.27）ng/ml、（15.74±3.85）pg/ml、（16.47±4.75）pg/ml、（2.18±0.57）ng/ml、0.28±0.10、1.38±0.54，非感染组为（62.42±14.68）mg/L、（0.89±0.21）ng/ml、（13.10±3.87）pg/ml、（14.57±3.35）pg/ml、（1.63±0.37）ng/ml、0.09±0.01、0.83±0.24，两组差异有统计学意义（P<0.001）。术后6 d，感染组的各实验室指标均显著高于未感染组（P<0.001）。ROC曲线分析结果显示，PCT、IG%、IG#均可以预测SCI术后早期感染（P<0.001），IG#的曲线下面积（AUC）显著低于PCT和IG%，分别为0.847、0.947、0.934（P<0.05）。相关性分析结果显示，IG%、IG#与PCT均呈显著相关，相关系数分别为0.724和0.472（P<0.001）。
结论：脊髓损伤患者术后24 h内升高的IG%、IG#、PCT水平对预测早期继发感染具有较高的敏感度与特异度，术后量化这些指标有助于早期识别具有感染高风险的患者。 |
| [关键词]:未成熟粒细胞 脊髓损伤 术后感染 |
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| Application value of immature granulocyte count in predicting early infection after spinal operation |
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Abstract:
Objective:To evaluate the early predictive value of immature granulocytes(IGs) in postoperative infection in patients with spinal injury.
Methods:The clinical data of 78 patients with spinal cord injury underwent surgery from October 2016 to October 2018 were collected. There were 57 males and 21 females,aged from 45 to 63 years old with an average of (55.2±6.1) years. The most common cause of injury was spinal trauma or degeneration. According to the American Spinal Cord Injury Association (ASIA) classification of spinal cord injury,37 cases were complete injury(grade A and B) and 41 cases were incomplete injury (grade C and D). All the 78 patients showed different degrees of deep and shallow sensory disturbances,and underwent CT and MRI examinations after admission. According to whether the secondary infection occurred within 1 week after surgery,the patients were divided into infected group and non-infected group. At the time of admission and 1,3,6 days after surgery,the immature granulocyte absolute value(IG#),immature granulocyte percentage(IG%),C-reactive protein(CRP),procalcitonin(PCT),interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-α (TNF-α) were detected. Using ROC curve to compare the predictive value of IG%,IG#,and PCT in early detection of postoperative infection. The correlation between IG%,IG# and PCT was analyzed using the Spearman correlation test.
Results:At a week after operation,33 patients occurred infection and 45 patients occurred no infection(infected group and non-infected group). All patients were followed up to no serious complications and deaths at the time of discharge. The proportion of complete injury in the infected group was significantly higher than that in the non-infected group(t=3.979,P=0.046),and the cervical and thoracic vertebrae were more common in the infected group,and the non-infected group was mostly lumbar injury(t=6.226,P=0.044). One day after surgery,PCT,IG%,IG# were resectively(0.71±0.10) ng/ml,1.08±0.10,0.20±0.05 in infected group,while in non-infected group were(0.51±0.08) ng/ml,0.82±0.13,0.13±0.04,there was significant difference between two groups(P<0.001). At 3 days postoperatively,CRP,PCT,IL-6,IL-1β,TNF-α,IG%,IG# were resectively (80.47±15.74) mg/L,(2.39±0.27) ng/ml,(15.74±3.85) pg/ml,(16.47±4.75) pg/ml,(2.18±0.57) ng/ml,0.28±0.10,1.38±0.54 in injected group,while in non-infected group were(62.42±14.68) mg/L,(0.89±0.21) ng/ml,(13.10±3.87)pg/ml,(14.57±3.35) pg/ml,(1.63±0.37) ng/ml,0.09±0.01,0.83±0.24,there was significant difference between two groups(P<0.001). At 6 days postoperatively,the laboratory parameters of the infected group were significantly higher than those of the non-infected group(P<0.001). ROC curve analysis showed that PCT,IG%,and IG# could predict early infection after spinal cord injury(P<0.001),and the area under the curve (AUC) of IG# was significantly lower than PCT and IG%(respectively 0.847,0.947,0.934,P<0.05). Correlation analysis showed that IG%,IG# and PCT were significantly correlated,and the correlation coefficients were 0.724 and 0.472,respectively(P<0.001).
Conclusion:The elevated levels of IG%,IG# and PCT in patients with spinal cord injury within 24 hours after surgery have high sensitivity and specificity for predicting early secondary infection. Postoperative quantification of these indicators helps early identification of patients with high risk of infection. |
| KEYWORDS:Immature granulocytes Spinal cord injury Postoperative infection |
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| 中文格式: | 吴瑞丽,李小斌,王斌,廉莉.未成熟粒细胞计数预测脊柱手术术后早期感染的应用价值[J].中国骨伤,2019,32(10):898~903 |
| 英文格式: | WU Rui-li,LI Xiao-bin,WANG Bin,LIAN Li.Application value of immature granulocyte count in predicting early infection after spinal operation[J].zhongguo gu shang / China J Orthop Trauma ,2019,32(10):898~903 |
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