脊柱术后感染病原菌及CD64和中性粒细胞百分比的早期预测价值

Early predictive value of pathogen distribution and percentage of CD64 and neutrophil in patients with postoperative spinal infection

目的分析脊柱术后医院感染患者病原菌分布特征及中性粒细胞64(CD64)和中性粒细胞百分比(NEU%)表达情况。方法选取2017年6月-2019年6月天津市天津医院收治的脊柱术后医院感染患者51例为感染组,并选取同期于医院就诊的脊柱术后未发生感染患者51例为未感染组。分析感染组患者病原菌情况,检测患者NEU和CD64水平;ROC曲线分析CD64和NEU%指标水平预测感染的诊断价值。结果 51例感染患者共培养分离病原菌78株,其中革兰阴性菌42株(53.85%)、革兰阳性菌33株(42.31%)、真菌3株(3.85%),以铜绿假单胞菌及金黄色葡萄球菌为主。术后7 d,感染组体温、WBC、中性粒细胞计数、CRP、ESR分别为(38.47±0.52)℃、(8.34±2.17)×109/L、(5.98±1.94)×109/L、(54.52±19.93)mg/L、(51.74±21.88)mm/h均高于非感染组(P<0.05)。术后7 d,感染组CD64、NEU%分别为(8.87±2.13)%、(84.93±13.39)高于非感染组(P<0.05)。CD64指数与NEU%水平诊断ROC曲线下面积分别为0.922、0.826。结论脊柱术后医院感染以革兰阴性菌为主,CD64及NEU%水平有助于脊柱术后医院感染的早期诊断。

OBJECTIVE To analyze the distribution characteristics of pathogenic bacteria and the expression of neutrophil 64(CD64) and neutrophil percentage(NEU%) in patients with nosocomial infection after spinal column surgery. METHODS A total of 51 patients with nosocomial infection after spinal surgery admitted to Tianjin Hospital from Jun. 2017 to Jun. 2019 were selected as the infection group, and 51 patients without postoperative infection admitted to the hospital during the same period were selected as non-infected group. The distribution of pathogenic bacteria of patients in the infected group was analyzed by automatic microorganism identification instrument, and the NEU% levels of patients were detected by blood routine analyzer, and CD64 levels were detected by Flow cytometry. The diagnostic value of ROC CD64 and NEU% index for predicting infection were analyzed by ROC curve. RESULTS A total of 78 pathogenic bacteria were isolated from 51 infected patients, including 42 strains of Gram-negative bacteria(53.85%), 33 strains of Gram-positive bacteria(42.31%), and 3 strains of fungi(3.85%), mainly dominated by Pseudomonas aeruginosa and Staphylococcus aureus. At 7 days after surgery, the body temperature, WBC, neutrophil count, CRP and ESR of the infected group were(38.47±0.52)℃,(8.34±2.17)×109/L,(5.98±1.94)×109/L,(54.52±19.93)mg/L, and(51.74±21.88)mm/h, respectively, significantly higher than those of the non-infected group(P<0.05). At 7 days after operation, the CD64 and NEU% of the infected group were(8.87±2.13)% and(84.93±13.39), respectively, significantly higher than those of the non-infected group(P<0.05). The area under the ROC curve of CD64 index and NEU% level for infection diagnosis was 0.922 and 0.826, respectively. CONCLUSION Nosocomial infections after spinal surgery are mainly Gram-negative bacteria. The levels of CD64 and NEU% are helpful for the early diagnosis of nosocomial infection after spinal surgery.