外周血淋巴细胞总数在颈椎术后感染早期诊断中的应用价值

The application of Peripheral blood lymphocyte in early diagnosis of spinal postoperative surgical site infection

中文关键词:  颈椎手术  手术部位感染  淋巴细胞

英文关键词:Cervical surgery  Surgical site infection  Lymphocytes

中文摘要:

  【摘要】 目的：探讨外周血中淋巴细胞总数在颈椎术后手术部位感染（surgical site infection，SSI）早期诊断中的应用价值。方法：回顾性分析复旦大学附属华山医院脊柱外科2001年1月～2015年10月收治的颈椎术后SSI患者18例（浅表切口感染7例，深部切口感染11例），以及性别、年龄、症状及手术方式相同的术后未感染患者47例。所有研究对象术前及术后3d检测并分析体温、外周血中白细胞总数、中性粒细胞总数、淋巴细胞总数、红细胞沉降率（erythrocyte sedimentation rate，ESR）及C-反应蛋白（C-reactive protein，CRP）等参数。绘制术后3d工作特征曲线（ROC曲线），并计算各项参数曲线下面积（AUC）；同时，使用约登指数分析各项参数的最佳临界值。采用 SPSS 12.0统计软件对测量数据进行统计分析。结果：术前，仅深部切口感染患者的淋巴细胞总数较非感染患者出现显著减少（P=0.01）。术后3d，浅表切口感染与深部切口感染患者的淋巴细胞总数均较术后未感染患者出现明显下降（P=0.02）；除此之外，仅深部切口感染患者的CRP及ESR值较未感染患者出现异常升高（P=0.00）。根据术后3d的ROC曲线，仅淋巴细胞总数（P=0.00）与CRP（P=0.01）对颈椎术后SSI具有诊断价值。相较于CRP（0.71），淋巴细胞总数的AUC值（0.97）明显较大。同时，淋巴细胞总数的约登指数（0.944；临界值1.31×109/L）也明显大于CRP（0.424；临界值14.7mg/L）。结论：颈椎术后围手术期淋巴细胞总数的异常减少与颈椎术后SSI的产生存在明显的相关性。术后早期，检测外周血中淋巴细胞总数有助于早期诊断颈椎术后SSI，为预防及尽早针对性应用抗生素治疗颈椎术后SSI提供可靠依据。

英文摘要:

  【Abstract】 Objectives: To explore the early diagnostic value of peripheral blood lymphocyte in evaluating cervical SSI. Methods: A total of 18 patients with cervical SSI(from Huashan hospital of Fudan university, 2001.1-2015.10) and age-and height-match 47 patients without SSI were analyzed retrospectively in this study. All patients were retrospectively analyzed white blood cells, neutrophils, lymphocytes, erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) before operation and 3 days after surgery. Receiver operating characteristic curve(ROC) of the above-mentioned parameters in postoperative 3 days was analyzed, and the area under curve(AUC) was measured. Furthermore, the critical value of each measurements was measured by using Youden index. All data were analyzed by SPSS 12.0. Results: Preoperatively, only lymphocytes in deep SSI patient group decreased significantly compared to the patients without SSI(P=0.01). Postoperatively, the lymphocytes of both superficial and deep SSI were significantly lower than those of the patients without SSI(P=0.02). In addition, compared to those without SSI, only CRP and ESR in the patients with deep SSI were demonstrated to be abnormally increased(P=0.00). According to ROC curve, both CRP(P=0.01) and lymphocytes(P=0.00) had significant diagnosis value in evaluating cervical SSI(P<0.05). Compared to the AUC(0.71) of CRP, lymphocytes had relatively larger AUC(0.97), and Youden index of lymphocytes(0.944; critical value 1.31×109/L) was also larger than that of CRP(0.424; critical value 14.7mg/L). Conclusions: There was a close relationship between abnormal changes of lymphocytes and the occurrence of spinal postoperative SSI. Early postoperative observation of abnormal degree in the peripheral blood lymphocytes can effectively predicting the occurrence of SSI.