老年股骨颈骨折患者围手术期PD-1表达水平对预测术后感染的临床应用价值

Clinical value of PD-1 expression in predicting postoperative infection in elderly patients with femoral neck fractures during perioperative period

目的探讨老年股骨颈骨折患者围手术期PD-1表达水平对预测术后感染的临床应用价值。方法选取本院2018年5月~2019年2月收治的121例老年股骨粗隆间骨折患者为研究对象,根据术后28 d是否出现术后感染将患者分为A、B两组,A组为术后出现感染患者,B组为未出现感染患者,通过流式细胞术检测入院后第1 d、术后第1 d、术后第3 d及术后第5 d外周血T细胞PD-1表达水平,采用ROC曲线判断PD-1预测感染并发症的cutoff值、敏感性及特异性。结果术后28 d进行随访,有25例患者在28 d内出现了感染,其发生率为13.93%,B组患者96例,A组患者25例。B组患者平均出血量低于A组患者,且28 d死亡率低于A组患者(P<0.05);术后老年股骨颈骨折患者外周血T细胞PD-1表达增高,有感染并发症的老年股骨颈骨折患者术后外周血T细胞PD-1表达持续增高,与术前相比差异均具有统计学意义(P<0.05),B组患者外周血T细胞的PD-1表达仅在术后第1 d增加,与术后第3 d、术后第5 d及术前相比差异具有统计学意义(P<0.05);术后第3 d与术后第1 d T细胞PD-1表达的差值对术后28 d内感染并发症发生的敏感性和特异性均较高(P<0.05)。结论老年股骨颈骨折患者髓内针内固定术治疗后,术后第3 d与术后第1 d T细胞PD-1表达的差值可能为预测术后感染并发症的参考指标。

Objective To explore the clinical application value of PD-1 expression in predicting postoperative infection in elderly femoral neck fractures during perioperative period.Methods A total of 121 elderly patients with intertrochanteric fractures treated in our hospital from May 2018 to February 2019 were selected as the research subjects.Patients were divided into two groups,A and B,according to whether there was postoperative infection on the 28 th day after operation.Group A was the patient with postoperative infection,and group B was the patient without infection.Flow cytometry was used to detect PD-1 expression in peripheral blood T cells on the 1 st day after admission,on the 1 st day after surgery,on the 3 rd day after surgery,and on the 5 th day after surgery.ROC curve was used to judge the cutoff value,sensitivity and specificity of PD-1 in predicting infection complications.Results During the 28-day follow-up,25 patients developed infection within 28 days,the incidence rate was 13.93%,96 patients in group B and 25 patients in group A.The average bleeding volume of group B patients was lower than that of group A patients,and the 28-day mortality rate was lower than that of group A patients(P<0.05);PD-1 expression in postoperative elderly patients with femoral neck fractures was increased,peripheral blood T cell PD-1 expression in elderly patients with femoral neck fractures with infection complications continued to increase,and the differences were statistically significant compared with preoperative(P<0.05).PD-1 expression of peripheral blood T cells in group B increased only on the 1 st day after surgery,and the difference was statistically significant compared with the 3 rd day,the 5 th day after surgery,and before surgery(P<0.05);The difference in T-cell PD-1 expression between the 3 rd day and the 1 st day after surgery was more sensitive and specific to infection complications within 28 days after surgery(P<0.05).Conclusion The difference between the expression of PD-1 on T cells 3 d and 1 d after the treatment of intramedullary needle internal fixation in elderly patients with femoral neck fractures may be a reference index for predicting postoperative infection complications.