中性粒/淋巴比和C-反应蛋白/白蛋白比预测脊柱术后感染△（开放获取）

Predictive value of neutrophils / lymphocytes ratio and C-reactive protein/albumin ratio for postoperative infection of spinal surgery

摘要:

[目的] 探讨中性粒细胞与淋巴细胞比值（neutrophils to lymphocytes ratio, NLR） 联合C-反应蛋白/白蛋白[(C-reactiveprotein, CRP) / (albumin, ALB), CRP/ALB] 比值对脊柱疾病患者术后感染的预测价值。[方法] 选取2018 年10 月—2022 年5 月在本院进行手术的145 例脊柱疾病患者作为研究对象，收集患者一般资料。根据术后7 d 内是否发生感染分为未感染组127 例和感染组18 例。单项因素比较和二元多因素逻辑回归分析感染发生的相关因素。受试者工作特征曲线（receiver operating characteristiccurve, ROC） 分析评估NLR、CRP/ALB 比值对术后感染的预测价值。[结果]两组患者性别、身体指数（BMI）、手术部位差异无统计学意义（P＞0.05），但是感染组在年龄[(67.2±5.8) 岁vs (58.3±4.6) 岁, P＜0.001]，手术时间[(189.4±22.7) min vs (167.3±23.1) min, P＜0.001]，输血比率[是/否, (12/6) vs (52/75), P=0.040]、内固定比率[是/否, (10/8) vs (29/98), P=0.003], 术后NLR [(7.5±2.0) vs (4.7±1.3), P＜0.001] 和CRP/ALB [(3.5±0.6) vs (2.4±0.4), P＜0.001] 均显著高于未感染组。逻辑回归分析表明，年龄大（OR=3.651, P=0.001）、使用内固定（OR=2.362, P=0.038）、术后CRP/ALB 升高（OR=2.324, P=0.002）、术后NLR 升高（OR=1.681, P=0.011）、手术时间长（OR=1.584, P=0.043）、术中输血（OR=1.333, P=0.003） 是术后发生感染的独立危险因素。ROC 分析表明，术后NLR、CRP/ALB 比值单独及联合预测术后发生感染的ROC 曲线下面积分别为0.857（95%CI 0.785~0.934）、0.956（95%CI 0.898~1.000）、0.982（95%CI0.912~1.000）。[结论] 脊柱疾病患者术后感染NLR、CRP/ALB 比值显著升高，其单独及联合检测均有预测价值。

Abstract:

[Objective] To explore the predictive value of neutrophils/lymphocytes ratio (NLR) and C-reactive protein (CRP)/albumin(ALB) ratio (CRP/ALB) for postoperative infection of spinal surgery. [Methods] A total of 145 patients who underwent surgery for spinal dis-eases in our hospital from October 2018 to May 2022 were included into this study, with data collected. According to whether infection oc-curred within 7 days after operation, 127 cases were fall into the uninfected group, while other 18 cases were in the infected group. Univari-ate comparison and binary multi-factor logistic regression analysis were used to analyze the related factors of infection. In addition, receiveroperating characteristic curve (ROC) was used to evaluate the predictive value of NLR and CRP/ALB ratio for postoperative infection. [Results] There was no significant difference in sex, body mass index (BMI) and surgical site between the two groups (P＞0.05), but infectedgroup proved significantly greater than the uninfected group in terms of age [(67.2±5.8) years vs (58.3±4.6) years, P＜0.001], the operationtime [(189.4±22.7) min vs (167.3±23.1) min, P＜0.001], blood transfusion ratio [Yes/No, (12/6) vs (52/75), P=0.040], internal fixation ratio[Yes/No, (10/8) vs (29/98), P=0.003], postoperative NLR [(7.5±2.0) vs (4.7±1.3), P＜0.001] and CRP/ALB [(3.5±0.6) vs (2.4±0.4), P＜0.001].As results of logistic regression analysis, the older age (OR=3.651, P=0.001), internal fixation (OR=2.362, P=0.003), CRP/ALB ratio (OR=2.324, P=0.002), elevated postoperative NLR (OR=1.681, P=0.011), longer operation time (OR=1.584, P=0.043), intraoperative blood trans-fusion (OR=1.333, P=0.003) were independent risk factors for postoperative infection. Regarding to ROC analysis, the areas under the ROCcurve for predicting postoperative infection by NLR and CRP/ALB ratio alone, as well as combination of the two were of 0.857 (95% CI0.785~0.934), 0.956 (95%CI 0.898~1.000) and 0.982 (95%CI 0.912~1.000), respectively. [Conclusion] The NLR and CRP/ALB ratios are