淋巴细胞总量及比例变化在脊柱退变性疾病术后伤口感染早期诊断中的应用  

Clinical Application of Peripheral Blood Lymphocyte and Proportion Change in Early Diagnosis of Wound Infection after Surgery of Spinal Degenerative Diseases

作　　者：沙卫平[1] 陈国兆 王黎明[1] SHA Wei-ping;CHEN Guo-zhao;WANG Li-ming(Department of Orthopaedics,the First People’s Hospital of Zhangjiagang,Zhangjiangang 215600,China)

机构地区：[1]张家港市第一人民医院骨科,江苏张家港215600

出　　处：《骨科》2021年第6期513-517,共5页ORTHOPAEDICS

基　　金：苏州市科技发展计划(SYSD2018006)。

摘　　要：目的探讨外周血淋巴细胞总量及其比例变化在脊柱退变性疾病术后伤口感染早期诊断中的临床应用价值。方法回顾性分析我院脊柱外科2015年1月至2020年12月脊柱退变性疾病手术后发生伤口感染的病人20例(其中颈椎手术6例,腰椎手术14例;浅表软组织感染9例,深部感染11例),设为感染组。同时选取同期术后未感染的病人20例纳入对照组。对比分析病人术前及术后3、7、14 d外周血中的白细胞总数、中性粒细胞总数、淋巴细胞总数、淋巴细胞比例、C反应蛋白(CRP)、红细胞沉降率(ESR)等参数变化。结果感染组术后3、7、14 d的CRP、ESR、白细胞总数、中性粒细胞总数均较术前显著提高,且随着时间推移逐步下降;同一观察时间点,感染组的数值均明显高于对照组,差异有统计学意义(P<0.05);但中性粒细胞总数和ESR在术后3 d和7 d的变化比较,差异无统计学意义(P>0.05)。感染组术后3、7、14 d的外周血淋巴细胞总数及淋巴细胞比例较术前明显下降,且随着时间推移逐步上升;且感染组术后3、7 d的淋巴细胞总数和术后3、7、14 d的淋巴细胞比例均显著低于对照组,差异有统计学意义(P<0.05)。对照组术前及术后3、7、14 d的外周血淋巴细胞总数及淋巴细胞比例两两比较,差异均无统计学意义(P>0.05)。感染组病人术后3 d淋巴细胞总数及其比例的ROC曲线下面积(AUC)分别为0.980、1.000,约登指数分别为0.900、1.000,最佳临界值分别为1.545×10^(9)/L、0.265;术后7天的AUC分别为0.898、1.000,约登指数分别为0.750、1.000,最佳临界值分别为1.670×109/L、0.280。结论同CRP、白细胞总数变化一样,术后早期分析外周血中淋巴细胞总数及比例变化同样有助于脊柱手术术后感染的早期诊断,为早期针对性治疗提供可靠依据。Objective To explore the clinical value of peripheral blood lymphocyte and proportion change in the early diagnosis of wound infection after the surgery of spinal degenerative diseases.Methods A total of 20 patients with wound infection after the surgery of spinal degenerative diseases from January 2015 to December 2020 in Department of Orthopaedics of our hospital were retrospectively analyzed,including 6 cases of cervical vertebrae diseases and 14 cases of lumbar vertebrae diseases;9 cases of superficial soft tissue infection and 11 cases of deep infection.Totally,20 uninfected patients were selected as the control group.The total number of white blood cells,nentrophils,lymphocytes,the proportion of lymphocytes,C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)before and 3,7 and 14 days after surgery were analyzed.Results CRP,ESR,total leukocytes and total neutrophils in the infection group at 3,7 and 14 days after operation were significantly higher than those before operation,and gradually decreased with time;at the same time,the values in the infection group were significantly higher than those in the control group(P<0.05).There was no significant difference in the total number of neutrophils and ESR between 3 and 7 days after operation(P>0.05).In the infection group,the total number and proportion of peripheral blood lymphocytes decreased significantly at 3,7 and 14 days after operation,and gradually increased with time;the total number of lymphocytes in the infection group at 3 and 7 days after operation and the proportion of lymphocytes at 3,7 and14 days after operation were significantly reduced as compared with those in the control group(P<0.05).There was no significant difference in the total number and proportion of peripheral blood lymphocytes in the control group before operation and 3,7 and 14 days after operation(P>0.05).The area under the ROC curve(AUC)of the total number of lymphocytes and the proportion of lymphocytes at 3 rd day after operation in the infection group was 0.980 and 1.0

关 键 词：淋巴细胞 脊柱退变性疾病 手术治疗 感染 

分 类 号：R687.3[医药卫生—骨科学]