基于淋巴细胞比值评分的胫骨平台骨折手术部位感染风险的网络计算器  

Web-based calculator based on lymphocytes ratios in prediction of risk of surgical site infection in patients with tibial plateau fractures

作　　者：张亮[1] 乐军[1] 傅晓婷 杨贺杰[1] 孟亚轲 ZHANG Liang;YUE Jun;FU Xiao-ting;YANG He-jie;MENG Ya-ke(Hangzhou TMC Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou,Zhejiang 310006,China)

机构地区：[1]浙江中医药大学附属杭州市中医院骨伤科,浙江杭州310006

出　　处：《中华医院感染学杂志》2024年第5期743-748,共6页Chinese Journal of Nosocomiology

基　　金：浙江省中医药管理局基金资助项目(2020ZB163)。

摘　　要：目的基于四种淋巴细胞比值相关的炎症-免疫反应标志物构建中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)和C-反应蛋白与淋巴细胞比值(CLR)淋巴细胞比值评分(NPMC-Ls)并开发胫骨平台骨折(TPF)患者手术部位感染(SSI)风险的网络计算器。方法选取2021年1月-2023年5月浙江中医药大学附属杭州市中医院骨伤科治疗的TPF患者197例为研究对象,根据患者术后是否发生SSI,分为SSI组31例,无SSI组166例。收集患者术前四种淋巴细胞比值相关的炎症-免疫反应标志物,包括NLR、PLR、MLR和CLR。通过多因素Logistic回归分析确定SSI风险危险因素。使用R语言中rms、survival、dca.R和Dyn Nom等包开发TPF患者SSI风险的网络计算器。结果197例TPF患者中,SSI发生率为15.74%(31/197)。SSI组患者NLR、PLR、MLR和CLR均高于无SSI组患者(P<0.05)。NLR、PLR、MLR、CLR的最佳截断值分别为3.02、203.23、0.56及39.73。多因素Logistic回归分析结果显示年龄、体质量指数(BMI)、NPMC-Ls为TPF患者术后SSI的危险因素(P<0.05)。包含年龄、BMI和NPMC-Ls的网络计算器(https://npmcls.shinyapps.io/TPF_SSIapp/)可以有效预测TPF患者SSI风险。结论年龄、BMI和NPMC-L与TPF患者SSI风险相关。网络计算器可以协助临床医生有效预测SSI风险从而采取相应的预防和治疗措施。OBJECTIVE To establish the web-based calculator of neutrophil-lymphocyte ratio(NLR),platelet-lym-phocyte ratio(PLR),monocyte to lymphocyte ratio(MLR),C-reactive protein to lymphocyte ratio(CLR)and NPMC-Ls based on four types of lymphocytes ratios-related markers of inflammation-immune response and ana-lyze the value in prediction of risk for surgical site infection(SSI)in the patients with tibial plateau fractures(TPF).METHODS A total of 197 patients with TPF who were treated in department of orthopedics and trauma-tology of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chi-nese Medicine from Jan 2021 to May 2023 were recruited as the research subjects and were divided into the SSI group with 31 cases and the no SSI group with 166 cases according to the status of postoperative SSI.The 4 types of preoperative lymphocytes ratios-related inflammation-immune response markers,including NLR,PLR,MLR and CLR,were collected from the patients.The multivariate logistic regression analysis was performed to deter-mine the risk factors for the SSI.The web-based calculator for the risk of SSI was developed by rms,survival,dca.R and DynNom of R language.RESULTS Among the 197 TPF patients,the incidence of SSI was 15.74%(31/197).The NLR,PLR,MLR and CLR of the SSI group were significantly higher than those of the no SSI group(P<0.05).The optimal cutoff values of NLR,PLR,MLR and CLR were 3.02,203.23,0.56 and 39.73,respectively.The result of multivariate logistic regression analysis showed that the age,body mass index(BMI)and NPMC-Ls were the risk factors for the postoperative SSI in the TPF patients(P<0.05).The web-based calcu-lator containing the age,BMI and NPMC-Ls(https://npmcls.shinyapps.io/TPF_SSIapp/)could effectively pre-dict the risk of SSI in the TPF patients.CONCLUSION The risk of SSI in the TPF patients is associated with the age,BMI and NPMC-Ls.The web-based calculator can help clinicians to effectively predict the risk of SSI so as to take the targeted prevention and

关 键 词：胫骨平台骨折 手术部位感染 淋巴细胞 炎症 免疫 网络计算器 列线图 

分 类 号：R619.3[医药卫生—外科学]