椎间孔镜术后椎间盘感染患者血清炎症细胞因子水平的变化

Change of serum inflammatory cytokines of percutaneous transforaminal endoscopic discectomy patients with postoperative intervertebral disc infection

目的探讨椎间孔镜术后椎间盘感染患者血清炎性因子的水平变化,为术后椎间盘感染的防治提供参考。方法选择2015年1月-2018年12月于丽水市中心医院行椎间孔镜术患者作为研究对象,其中感染患者50例作为感染组,随机抽取未感染患者50例为对照作为未感染组。分析患者感染病原学特点,观察患者术前及术后第1天、第3天、第5天血清C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)、肿瘤坏死因子(Tumor necrosis factor-α,TNF-α)和血清降钙素原(Procalcitonin, PCT)的水平变化。结果 50例感染患者共检出病原菌57株,革兰阳性菌41株(71.93%),革兰阴性菌16株(28.07%),引起术后感染的病原菌主要是金黄色葡萄球菌和大肠埃希菌。两组患者术前炎症因子CRP、IL-6、TNF-α和PCT水平比较无明显差异;手术后第1天、第3天、第5天感染组患者上述指标水平较术前均升高(P<0.05),未感染组术后第1天上述指标水平显著升高,术后第3天、第5天逐渐下降,两组患者比较差异有统计学意义(P<0.05)。结论椎间孔镜术后感染患者的感染病原菌以革兰阳性菌为主;术后感染患者血清炎症细胞因子明显上升,该结果对椎间孔镜术后感染的诊断具有一定的临床指导价值。

OBJECTIVE To explore the change of serum inflammatory cytokines of the percutaneous transforaminal endoscopic discectomy patients with postoperative intervertebral disc infection so as to provide guidance for prevention and treatment of postoperative intervertebral disc infection.METHODS The patients who underwent the percutaneous transforaminal endoscopic discectomy in Lishui Central Hospital from Jan 2015 to Dec 2018 were recruited as the study objects,50 patients with infection were assigned as the infection group,and 50 patients without infection were randomly chosen as the control group.The etiological characteristics of the infection were observed,and the levels of serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and serum procalcitonin(PCT)of the patients were observed before the surgery and after the surgery for 1,3 and 5 days.RESULTS Totally 57 strains of pathogens were isolated from 50 patients with infection,41(71.93%)of which were gram-positive bacteria,and 16(28.07%)were gram-negative bacteria.Staphylococcus aureus and Escherichia coli were the predominant species of pathogens causing the postoperative infection.There were no significant differences in the levels of inflammatory factors CRP,IL-6,TNF-αand PCT between the two groups of patients before the surgery;the levels of above indexes of the infection group were significantly higher after the surgery for 1,3 and 5 days than before the surgery(P<0.05);the levels of above indexes of the non-infection group were significantly elevated after the surgery for 1 day and then declined after the surgery for 3 and 5 days(P<0.05).CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the postoperative infection in the percutaneous transforaminal endoscopic discectomy patients.The levels of serum inflammatory cytokines of the patients with postoperative infection are significantly elevated,which has certain clinical value in diagnosis of the postoperative infection in the percutaneous transforaminal endoscopic discectomy patients.