淋巴细胞计数及百分比预测膝关节置换术后早期感染的价值  

The value of lymphocyte count and percentage in predicting the early infection after knee arthroplasy

作　　者：蔡礼权 黄雁斌 方凯彬 张小路[1] CAI Li-Quan;HUANG Yan-Bin;FANG Kai-Bing(The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属第二医院,福建泉州362000

出　　处：《吉林医学》2024年第7期1565-1569,共5页Jilin Medical Journal

基　　金：福建省自然科学基金项目[项目编号:2019J01472]。

摘　　要：目的:探讨术后淋巴细胞计数及百分比预测全膝关节置换术(TKA)术后早期感染的临床应用价值。方法:回顾性分析2018年12月~2022年12月福建医科大学附属第二医院行TKA治疗的345例患者的临床资料,分为感染组(n=27)与未感染组(n=318),记录并比较两组患者年龄、性别、体重指数(BMI)、手术时间、术中出血量、手术前后血红蛋白差值及各项实验室资料[术前和术后第1天、第4天C反应蛋白(CRP)、红细胞沉降率(ESR)水平、白细胞计数、中性粒细胞和淋巴细胞计数及百分比]。使用SPSS统计学软件处理数据,选取两组样本具有统计学差异的指标后,使用Pearson相关系数进行相关性检验,最后,使用Stata软件做受试者工作特征(ROC)曲线下面积(AUC)、95%CI及P值,并得出所选标志物的诊断临界值及其敏感性、特异性。结果:两组手术年龄、性别、BMI、手术时间、术中出血量、术前术后血红蛋白差值及术前的实验室标志物结果比较差异均无统计学意义(均P>0.05)。两组术后4 d CRP水平、中性粒细胞计数及百分比、术后1 d和4 d的淋巴细胞计数及其百分比比较,差异均有统计学意义(P<0.05)。Pearsons相关性检验发现未感染组中与手术因素(手术时间、术中出血量)均无关的标志物为术后4 d淋巴细胞计数及百分比。本研究采用Stata软件做ROC曲线来得出TKA术后早期感染的术后4 d淋巴细胞百分比及其计数的合适的诊断临界值。术后4 d淋巴细胞百分比的ROC曲线下面积AUC为0.755[95%CI(0.528,0.918),P=0.28],根据Youden指数计算淋巴细胞百分比的最佳预测临界值为<20.0%,利用预测临界值进行诊断试验,此时的敏感性为91.67%,特异性为55.56%;术后4 d淋巴细胞计数的ROC曲线下的面积AUC为0.833[95%CI(0.637,0.970),P=0.28],根据Youden指数计算淋巴细胞计数的最佳预测临界值为<1500/μL。利用预测临界值进行诊断试验,此时的敏感性为91.67%,特�Objective To investigate the value of lymphocyte count and percentage in predicting early infection after knee joint arthroplasy.Method A retrospective analysis was made of the age,gender,BMI,operative time,intraoperative blood loss and laboratory data(C-reactive protein,erythrocyte sedimentation rate,white blood cell count,neutrophil and lymphocyte count and percentage on preoperative and postoperative days 1 and 4)of 345 patients,including 27 cases of early postoperative infection group,no infection group in 318 cases,who underwent unilateral total knee arthroplasty in our hospital from December 2018 to December 2022.The operative time,age,gender,BMI,intraoperative blood loss and the difference in preoperative and postoperative hemoglobin between the two groups were recorded.Use SPSS statistical software was used to process the data.After selecting indexes with statistical differences,Pearson′s correlation coefficient was used for correlation test to determine which markers were irrelevant to surgical factors(operation time and intraoperative blood loss).Finally,use Stata software to calculate the area under the ROC curve,95%CI,and p-value,and obtain the diagnostic threshold,sensitivity,and specificity of the selected biomarkers.Results There was no statistically significant difference between two groups in surgical age,gender,BMI,operative time,intraoperative blood loss,preoperative and postoperative hemoglobin difference,and laboratory markers before surgery(all P>0.05).There were statistically significant differences in CRP level,neutrophil count and percentage at 4 days after surgery,lymphocyte count and percentage 1 and at 4 days after surgery between the two groups(P<0.05).Pearsons correlational test found that in the non-infected group,markers unrelated to surgical factors(operation time,intraoperative blood loss)were lymphocyte count and percentage 4 days after operation.We used the ROC curve of the stata software to determine the appropriate diagnostic threshold for the percentage of lymphocytes and

关 键 词：膝关节置换术后感染 实验室标志物 淋巴细胞计数及比例 早期感染 

分 类 号：R687.4[医药卫生—骨科学]