血清感染指標對頸后路單開門椎管擴大成形術后早期感染的診斷價值

摘    要：

目的：探討白細胞計數（WBC）、C-反應蛋白（CRP）、血清降鈣素原（PCT）及紅細胞沉降率（ESR）水平對頸后路單開門椎管擴大成形術后早期感染的診斷價值，及時發現、預防和治療術后感染患者。方法：回顧性分析2010年1月至2019年4月頸后路單開門椎管擴大成形術后早期發熱的患者120例；按照患者傷口滲出液細菌學培養的結果將其分為感染組（53例）和未感染組（67例），感染組中，男32例，女21例，年齡48～63(52.28±6.36）歲；未感染組中，男37例，女30例，年齡46～62(51.63±5.82）歲。并根據感染組患者術后感染類型將其分為深部手術部位感染組（30例）和淺表手術部位感染組（23例），深部手術部位感染組中，男19例，女11例，年齡50～63(53.16±5.62）歲；淺表手術部位感染組中，男13例，女10例，年齡48～61(52.15±5.68）歲。比較組間患者及組內患者手術前后WBC計數、CRP、PCT及ESR血清感染指標。收集納入的120例患者血清感染學指標數據并根據血清感染指標診斷感染的靈敏度及特異性，以1-特異性為橫坐標，靈敏度為縱坐標繪制受試者工作特征（ROC）曲線對WBC計數、CRP、PCT以及ESR感染指標進行早期感染診斷的準確性評估。結果：術前：感染組和未感染組患者的WBC計數、CRP、PCT、ESR血清感染指標水平相近（P>0.05）；術后：感染組患者的WBC計數、CRP、PCT、ESR感染指標較未感染組高（P<0.05）。在術后感染的患者中，WBC計數、CRP、PCT以及ESR血清感染指標水平在不同術后感染類型的患者中存在差異（P<0.05）。未感染組患者的WBC計數、CRP、PCT以及ESR血清感染指標總體呈現出先升后降的趨勢。WBC計數感染指標的受試者曲線下面積（AUC）為0.637(P<0.05);CRP感染指標的AUC為0.792(P<0.05);PCT感染指標的AUC為0.774(P<0.05);ESR感染指標的AUC為0.783(P<0.05）。結論：WBC計數、CRP、PCT、ESR血清感染指標可用于頸后路單開門椎管擴大成形術后早期感染的診斷，除此之外，上述4種感染指標變化的綜合分析可用于不同術后感染類型的鑒別。WBC計數指標對于早期感染診斷的準確性較低，CRP、PCT以及ESR指標對于早期感染診斷的準確性較好。總體上來說，CRP、PCT以及ESR血清感染指標對于頸后路單開門椎管擴大成形術后早期感染的診斷來說具有重要的臨床意義，有助于臨床工作者盡早發現術后早期感染以利于隨后的相應治療。

Abstract：

Objective:To investigate the diagnosis value of white blood cell(WBC) count,C-reactive protein(CRP),serum procalcitonin(PCT) and erythrocyte sedimentation rate(ESR) levels for early infection after posterior cervical expansive open-door laminoplasty.Discover,prevent,and treat postoperative infections promptly.Methods:The clinical data of 120 patients with early fever after posterior cervical laminoplasty from January 2010 to April 2019 were retrospectively analyzed.According to the results of bacteriological culture of wound exudate,the patients were divided into infected group(53 cases)and non-infected group(67 cases).In infection group,there were 32 males and 21 females,aged from 48 to 63 years old,with an average of(52.28±6.36) years.In non-infected group,there were 37 males and 30 females,aged from 46 to 62 years old,with an average of(51.63±5.82) years.According to the postoperative infection types,the patients in infection group were divided into 30 cases of deep surgical site infection group and 23 cases of superficial surgical site infection group.In deep surgical site infection group,there were 19 males and 11 females,aged from 50 to 63 years old with an average of(53.16±5.62)years.In superficial surgical site infection group,there were 13 males and 10 females,aged from 48 to 61 years old with an average of(52.15±5.68) years.WBC count,CRP,PCT and ESR serum infection indexes were compared between groups and within groups before and after surgery.The serum infective index data of 120 patients were collected and the sensitivity and specificity of the serum infectious index were used to diagnose the infection.Accuracy assessment of early infection diagnosis of WBC count,CRP,PCT and ESR serum infection indexes by plotting the receiver operating characteristic(ROC) curve with 1-specificity as the abscissa and sensitivity as the ordinate.Results:There were no significant difference in WBC count,CRP,PCT and ESR serum infection indexes between infected group and non-infected group before operation(P>0.05).Postoperative WBC count,CRP,PCT and ESR infection indexes in infection group were higher than in non-infected group(P<0.05).Among patients with postoperative infection,WBC count,CRP,PCT and ESR serum infection index levels were significantly different in the different postoperative infection types(P<0.05).In non-infected group,WBC count,CRP,PCT and ESR serum infection indexes showed an overall trend of rising first and then falling.The area under curve(AUC) of WBC count infection index was0.637(P<0.05).The AUC of CRP infection index was 0.792(P<0.05).The AUC of PCT infection index was 0.774(P<0.05).The AUC of ESR infection index was 0.783(P<0.05).Conclusion:WBC count,CRP,PCT and ESR serum infection indexes can be used for the diagnosis of early infection after posterior cervical expansive open-door laminoplasty.In addition,the comprehensive analysis of the changes of the four infection indexes can be used for the identification of different postoperative infection types.WBC count index is less accurate for early infection diagnosis,and CRP,PCT,and ESR indexes are more accurate for early infection diagnosis.In general,CRP,PCT and ESR serum infection indexes have important clinical significance for the diagnosis of early infection after posterior cervical open-door laminoplasty,which helps clinicians to detect early postoperative infection as early as possible to facilitate subsequent treatment.