围手术期免疫变化与腰椎减压手术部位感染的相关性  

Correlation between perioperative immune changes and surgical site infection after spinal surgery

作　　者：卢博 郭建刚 刘继权 田永福 高旭旺 LU Bo;GUO Jian-gang;LIU Ji-quan;TIAN Yong-fu;GAO Xu-wang(Department of Bone and Joint Infection,Luoyang Orthopedic Hospital of Henan Province(Henan Orthopedic Hospital),Zhengzhou,Henan 450000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)骨与关节感染科,河南郑州450000

出　　处：《颈腰痛杂志》2023年第1期64-66,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨腰椎减压术后C反应蛋白(C-reactive proteinCRP)、白细胞(white blood cell,WBC)、中性粒细胞(neutrophils,N)、淋巴细胞(lymphocyte,L)、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)对手术部位感染(surgical site infection,SSI)的预测价值。方法选择2016年1月~2020年12月在本院接受腰椎减压手术的573例患者,观察术后30 d内SSI发生率,分析CRP、N、L、NLR水平用于预测SSI的临床价值。结果术后30 d内有31例患者发生SSI,发生率为5.41%。SSI组术后7 d时WBC显著高于非SSI组(P<0.05)。术后1 d时,SSI组患者CRP显著高于非SSI组(P<0.05);术后3 d和术后7 d时,SSI组N、NLR、CRP水平显著高于非SSI组,L水平显著低于非SSI组(P<0.05)。术后1 d时,CRP预测SSI的AUC为0.763;术后3 d时,NLR、L、N、CRP预测SSI的AUC分别为0.770、0.742、0.732和0.842;术后7 d时,NLR、L、N、CRP预测SSI的AUC分别为0.870、0.828、0.846和0.883。结论SSI与淋巴细胞、NLR等免疫功能指标密切相关,这些标志物是预测腰椎减压术后SSI的有用指标,有助于确定预测SSI风险较高的患者。Objective To investigate the predictive value of C-reactive protein(CRP),white blood cell(WBC),neutrophils(N),lymphocyte(L)and neutrophil/lymphocyte ratio(NLR)in surgical site infection(SSI)after lumbar decompression.Methods From January 2016 to December 2020,573 patients who underwent lumbar decompression in our hospital were selected in the research,and the incidence of SSI within 30 days after operation was observed.The clinical value of CRP,N,L and NLR in predicting SSI was observed.Results In 573 patients,31 patients developed SSI within 30 days after operation,the incidence rate was 5.41%.WBC in SSI group was higher than that in non-SSI group at 7 days after operation(P<0.05).CRP in SSI group was higher than that in non-SSI group at 1 d after operation(P<0.05).The levels of N,NLR and CRP in SSI group were higher than those in non-SSI group at 3 and 7 days after operation,and the level of L was lower than that in non-SSI group(P<0.05).AUC of SSI predicted by CRP at 1 day after operation was 0.763.The AUC of SSI predicted by NLR,L,N and CRP at 3 days after operation were 0.770,0.742,0.732 and 0.842,respectively.The AUC of SSI predicted by NLR,L,N and CRP at 7 days after operation were 0.870,0.828,0.846 and 0.883,respectively.Conclusion SSI is closely related to immune function indicators such as lymphocytes and NLR.These markers are useful indicators for predicting SSI after lumbar decompression,and help to identify patients with high risk of SSI.

关 键 词：腰椎减压术 围手术期 手术部位感染 淋巴细胞 中性粒细胞 中性粒细胞与淋巴细胞比值 

分 类 号：R619.3[医药卫生—外科学]