术前血清C反应蛋白水平与胸腰骶椎结核术后未愈的关系

Relationship between preoperative serum C-reactive protein and postoperative non-healing in thoraco-lumbo-sacral vertebral tuberculosis patients

目的探讨术前血清C反应蛋白(CRP)水平与胸腰骶椎结核术后未愈的关系。方法回顾性分析2007年1月—2015年12月行一期病灶清除、椎间植骨融合内固定术治疗的123例胸腰骶椎结核患者的临床资料。根据术前CRP中位数(17.7 mg/L)将患者分为CRP>20 mg/L组(A组,n=57)和CRP≤20 mg/L组(B组,n=66),比较2组在年龄、性别、病程、术前合并症、术前抗结核治疗时间、术前白蛋白、病变部位、病变范围、手术入路等一般临床特征上的均衡性。观察术后1年随访期内结核病灶未愈情况,采用Cochran-Mantel-Haenszel(CMH)检验控制混杂因素并分析2组间未愈率的差异。结果 2组间性别、术前白蛋白存在不均衡,而年龄、病程、术前合并症、术前抗结核治疗时间、病变部位、病变范围、手术入路等特征差异无统计学意义。共12例(9.8%)患者术后未愈,A组和B组的未愈率分别为15.8%(9/57)和4.5%(3/66)。控制性别和术前白蛋白的影响后,得到A组未愈率高于B组,差异有统计学意义(P<0.05)。结论较高的术前CRP水平可能增加胸腰骶椎结核术后未愈风险,应重视手术时机选择,并在术前有效控制结核炎症。

Objective To explore the relationship between preoperative serum C-reactive protein(CRP)with postoperative non-healing in thoraco-lumbo-sacral vertebral tuberculosis patients.Methods All 123 thoraco-lumbo-sacral vertebral tuberculosis patients who were treated by one-stage debridement,bone graft fusion and internal fixation between January 2007 and December 2015 were retrospectively analyzed.According to the median preoperative CRP(17.7 mg/L),the patients were divided into group A(with CRP>20 mg/L,n=57)and group B(with CRP≤20 mg/L,n=66).The general characteristics were compared between 2 groups,including age,gender,course of disease,preoperative comorbidities,duration of preoperative anti-TB treatment,preoperative albumin,location and extent of spinal lesion and surgical approach.Postoperative non-healing was collected during 1-year follow-up period.Cochran-Mantel-Haenszel tests were conducted to control the confounding factors and analyze the differences in postoperative non-healing rate between 2 groups.Results Postoperative non-healing was observed in 12 cases(9.8%).There were differences in gender and preoperative albumin between 2 groups.While there was no difference in age,course of disease,preoperative comorbidities,duration of preoperative anti-TB treatment,location and extent of spinal lesion and surgical approach.The postoperative non-healing rates of groups A and B were 15.8%(9/57)and 4.5%(3/66),respectively.After controlling for gender and preoperative albumin,the non-healing rate of group A was significantly higher than that of group B(P<0.05).Conclusion A higher level of preoperative CRP might increase the risk of postoperative non-healing in thoraco-lumbo-sacral vertebral tuberculosis patients,therefore suitable surgical timing and effective management of preoperative inflammation in these patients should be emphasized.