老年腰椎手术患者术后切口感染的危险因素及血清PCT、CRP、SAA水平的诊断价值

Risk factors of incision infection and diagnostic value of serum PCT,CRP and SAA in elderly patients after lumbar surgery

中文关键词: 老年  腰椎间盘突出  手术治疗  切口感染  危险因素  降钙素原  C-反应蛋白  血清淀粉样蛋白A

英文关键词: elderly  lumbar disc herniation  surgical treatment  incision infection  risk factor  procalcitonin  C-reactive protein  serum amyloid A

中文摘要:

      目的 探讨老年腰椎手术患者术后切口感染的危险因素及血清降钙素原(PCT)、C-反应蛋白(CRP)、淀粉样蛋白A(SAA)水平的诊断价值,旨在为感染的防治提供新依据.方法 回顾性分析2020 年1 月—2023 年8 月南京医科大学第四附属医院发生腰椎间盘突出术后切口感染的老年患者和同期未发生术后切口感染的老年患者的临床资料,前者纳入感染组(n =38),后者纳入未感染组(n =78).比较2 组PCT、CRP及SAA水平差异,并应用ROC分析判断其联合检测对早期诊断患者术后切口感染的价值;同时应用Logistic回归分析术后切口感染发生的危险因素.结果 感染组PCT、CRP及SAA水平均高于未感染组(P＜0.05);ROC曲线分析结果显示,PCT、SAA、CRP联合检测的早期诊断切口感染的灵敏度、特异度均高于单一指标检测(P＜0.05);单因素分析显示,2 组年龄、BMI、营养状态、PCT水平、CRP水平、SAA水平、糖尿病史、手术时间、术中出血量、抗生素使用情况、住院时间方面比较,差异均有统计学意义(P＜0.05);多因素二元Logistic分析显示,PCT≥1.37 ng/mL、CRP≥90.10 mg/L、SAA≥162.35 mg/L、年龄≥75 岁、合并糖尿病、术中出血量≥300 mL是老年腰椎发生术后切口感染的独立危险因素(OR＞1,P＜0.05).结论 PCT、SAA、CRP水平与老年腰椎患者术后切口感染的发生发展有关,其指标联合诊断术后切口感染的价值较高,同时年龄≥75 岁、合并糖尿病、术中出血量≥300 mL也是术后切口感染发生的危险因素,术后感染防护有待进一步加强.

英文摘要:

      Objective To explore the risk factors of incision infection and diagnostic value of serum procalcitonin(PCT),C-reactive protein(CRP)and amyloid A(SAA)in elderly patients after lumbar surgery so as to provide new basis for the prevention and treatment of infection.Methods The clinical data of elderly patients with postoperative incision infec-tion and elderly patients without postoperative incision infection after lumbar disc herniation surgery treated in Fourth Affiliated Hospital of Nanjing Medical University from January 2020 to August 2023 were retrospectively analyzed.The former was in-cluded in the infected group(n =38),while the latter was included in the non-infected group(n =78).The levels of PCT,CRP and SAA were compared between the two groups.ROC curve analysis was used to determine the value of their combined detection in early diagnosis of postoperative incision infection.Logistic regression was used to analyze the risk factors for post-operative incision infection.Results The levels of PCT,CRP and SAA of the infected group were higher than those of the non-infected group(P＜0.05).The ROC curve analysis results showed that the sensitivity and specificity of the combined de-tection of PCT,SAA,and CRP in early diagnosis of incision infection were higher than those of single index detection(P＜0.05).Univariate analysis showed that there were statistically significant differences in age,BMI,nutritional status,PCT lev-el,CRP level,SAA level,diabetes history,operation time,intraoperative blood loss,antibiotic use and hospitalization time be-tween the two groups(P＜0.05).Multivariate binary Logistic analysis showed that PCT≥1.37 ng/mL,CRP≥90.10 mg/L,SAA≥162.35 mg/L,age≥75 years,combined with diabetes,and intraoperative bleeding≥300 mL were independent risk factors for incision infection in elderly patients(OR＞1,P＜0.05).Conclusion The levels of PCT,SAA,and CRP are re-lated to the occurrence and development of incision infection in elderly patients after lumbar surgery,and the diagnostic value of their combined detection for postoperative incision infections is high.Meanwhile,age≥75 years old,combined with diabetes,and intraoperative bleeding≥300 mL are risk factors for postoperative incision infection.The prevention of postoperative infec-tion needs to be further strengthened.