布鲁氏菌脊柱炎与化脓性脊柱炎在 炎性指标方面的鉴别诊断  

Differential diagnosis of brucellar spondylitis(BS)and pyogenic spondylitis(PS)based on inflammatory markers

作　　者：王延龙 黄异飞[2] 董振宇[2] 李昊楠 牙克甫·阿不力孜 盛伟斌[1] 荀传辉[1] WANG Yanlong;HUANG Yifei;DONG Zhenyu;LI Haonan;Yakefu Abulizi;SHENG Weibin;XUN Chuanhui(Department of Spine Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Spine Surgery,Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University,Urumqi 830099,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]新疆医科大学附属中医医院脊柱外科,乌鲁木齐830099

出　　处：《新疆医科大学学报》2025年第4期410-415,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01D18);国家自然科学基金项目(82360257)。

摘　　要：目的探讨中性粒细胞(Neutrophil,NEUT)、血浆纤维蛋白原(Fibrinogen,FBG)、红细胞沉降率(Erythrocyte Sedimentation Rate,ESR)和C反应蛋白(C-reactive protein,CRP)对布鲁氏杆菌脊柱炎(Brucellar spondylitis,BS)和化脓性脊柱炎(Pyogenic spondylitis,PS)的鉴别诊断价值。方法回顾性分析2012年1月-2023年9月于新疆医科大学第一附属医院脊柱外科就诊285名脊柱感染患者的病历资料,其中BS患者组共152例(53.3%),男性117例(77.0%)、女性35例(23.0%),年龄(46.0~60.0)岁,平均年龄(52.7±11.6)岁;PS患者组共133例(46.7%),男性83例(62.4%)、女性50例(37.6%),年龄(45.0~65.0)岁,平均年龄(53.9±14.7)岁。将两组患者血清的NEUT、FBG、ESR和CRP这4个血清炎性指标进行单一对比和联合对比,计算曲线下面积(Area under curve,AUC)、灵敏度、特异度、阳性预测值(Positive predictive value,PPV)和阴性预测值(Negative predictive value,NPV)。绘制单个血清炎性指标及多个血清炎性指标联合的工作特征曲线(Receiwer operating characteristic,ROC)曲线,通过AUC值分析单个血清炎性指标及多个血清炎性指标联合对BS与PS的鉴别效能。结果与BS组比较,PS组患者年龄差异无统计学意义(P>0.05),性别和4个血清炎性指标差异均有统计学意义(P<0.01)。单个血清炎性指标NEUT、FBG、ESR和CRP的ROC曲线下面积的AUC值分别是0.756、0.616、0.678、0.836,灵敏度分别是74.3%、38.8%、62.5%、67.8%,特异度依次为66.2%、79.7%、65.4%、83.5%,PPV分别是0.715、0.686、0.674、0.639、0.824,NPV分别是0.693、0.533、0.604、0.694。两个血清炎性指标联合NEUT+FBG、NEUT+ESR、NEUT+CRP、FBG+ESR、FBG+CRP、ESR+CRP的ROC曲线下面积的AUC值分别是0.756、0.776、0.839、0.694、0.846、0.834。3个血清炎性指标联合NEUT+FBG+ESR、NEUT+FBG+CRP、NEUT+ESR+CRP、FBG+ESR+CRP的ROC曲线下面积AUC值分别是0.776、0.848、0.839、0.843。4个血清炎性指标联合NEUT+FBG+ESR+CRP的ROC曲线下面积AUC值为0.847�Objective To investigate the differential diagnostic value of neutrophil count,plasma fibrinogen,erythrocyte sedimentation rate and C-reactive protein in Brucellar spondylitis(BS)and Pyogenic spondylitis(PS).Methods A retrospective analysis was conducted on the medical records of 285 patients with spinal infections who were treated in the hospital from January 2018 to September 2023.The BS group consisted of 152 cases(53.3%),including 117 males(77.0%)and 35 females(23.0%),with an age range of(46.0-60.0)years and a mean age of 52.7±11.6 years.The PS group consisted of 133 cases(46.7%),including 83 males(62.4%)and 50 females(37.6%),with an age range of(45.0-65.0)years and a mean age of 53.9±14.7 years.4 inflammatory markers,which was neutrophil count(NEUT),plasma fibrinogen(FBG),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)in the serum of the 2 groups were compared individually and in combination.The area under the curve(AUC),sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)were calculated.Receiver operating characteristic(ROC)curves were plotted for single inflammatory markers and combinations of multiple inflammatory markers.The differential efficacy of single and combined inflammatory markers for BS and PS was analyzed by the area under the curve(AUC).Results Compared with the BS group,there was no statistically significant difference in age among patients in the PS group(P>0.05),but there were statistically significant differences in gender and four serum inflammatory indicators(P<0.01).The AUC values of the ROC curves for individual serum inflammatory markers NEUT,FBG,ESR,and CRP were 0.756,0.616,0.678,and 0.836,respectively.The sensitivities were 74.3%,38.8%,62.5%,and 67.8%,respectively,and the specificities were 66.2%,79.7%,65.4%,and 83.5%,respectively.The PPVs were 0.715,0.686,0.674,0.639,and 0.824,and the NPVs were 0.693,0.533,0.604,and 0.694,respectively.The AUC values under the ROC curve of two serum inflammatory indicators combined with NEUT+FBG,

关 键 词：布鲁氏菌脊柱炎 化脓性脊柱炎 血清炎性指标 中性粒细胞 血浆纤维蛋白原 红细胞沉降率 C反应蛋白 性别因素 

分 类 号：R681.5[医药卫生—骨科学]