脊柱术后早期切口深部感染对Smad通路和凝血及感染指标的影响

Influence of early deep incision infection on Smad pathway, coagulation and infection indexes of spinal surgery patients

目的分析脊柱术后早期切口深部感染对Smad信号通路、凝血及感染指标的影响。方法以2016年1月-2019年12月在南阳医学高等专科学校第一附属医院脊柱外科收治的行脊柱内固定术的脊柱病变患者为研究对象,选取34例术后早期切口深部感染患者为病例组,54例术后未发生感染患者纳入对照组。比较两组Smad信号通路、凝血及感染指标,分析Smad通路、凝血及感染指标与早期切口深部感染的关系及其对早期切口深部感染的预测价值。结果病例组术前与术后3 d的Smad1、Smad2、Smad3、转化生长因子-β(TGF-β)、血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)差值,术前与术后3 d纤维蛋白原(Fib)差值,术前与术后3 d体温、白细胞计数(WBC)、中性粒细胞水平、C-反应蛋白(CRP)、红细胞沉降率(ESR)差值高于对照组,术前与术后3 d凝血酶原时间(PT)、凝血酶时间(TT)、组织型纤溶酶原激活物(t-PA)、纤溶酶原激活抑制物(PAI-I)差值低于对照组(P<0.05);术后3 d Smad2、术前与术后3 d PAI-I差值、术后3 d CRP均是脊柱内固定术后切口深部感染的独立影响因素;术后3 d Smad2曲线下面积(AUC)高于术前与术后3 d PAI-I差值、术后3 d CRP(P<0.001);以0.45ng/L为cut-off,其敏感度、特异度为91.18%、79.63%。结论脊柱内固定术患者术后3 d Smad2、术前与术后3 d PAI-I差值、术后3 d CRP水平与早期切口深部感染存在密切关联,可作为早期切口深部感染的预测因子。

OBJECTIVE To observe the influence of early deep incision infection on Smad pathway,coagulation and infection indexes of the spinal surgery patients.METHODS The patients with spinal diseases who underwent internal fixation of spine in spine surgery department of the First Affiliated Hospital of Nanyang Medical College from Jan 2016 to Dec 2019 were recruited as the study subjects,34 patients who had postoperative early deep incision infection were assigned as the case group,and 54 patients who did not have postoperative infection were set as the control group.The Smad pathway,coagulation and infection indexes were observed and comparted between the two groups,and the correlation between the Smad pathway,coagulation and infection indexes and the early deep incision infection as well as the values in prediction of early deep incision infection was analyzed.RESULTS The difference values of Smad1,Smad2,Smad3,transforming growth factor-β(TGF-β),vascular endothelial growth factor(VEGF)and interleukin-6(IL-6)before the surgery and after the surgery for 3 days,the difference value of fibrinogen(Fib)before the surgery and after the surgery for 3 days,and the difference values of body temperature,white blood cell(WBC)counts,neutrophil level,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)before the surgery and after the surgery for 3 days were significantly higher in the case group than in the control group;the difference values of prothrombin time(PT),thrombin time(TT),tissue-type plasminogen activator(t-PA)and plasminogen activation inhibitor(PAI-I)before the surgery and after the surgery for 3 days were significantly lower in the case group than in the control group(P<0.05).The Smad 2 after the surgery for 3 days,difference value of PAI-I before the surgery and after the surgery for 3 days and CRP after the surgery for 3 days were the independent influencing factors for the postoperative deep incision infection.The area under curve(AUC)of the Smad2 after the surgery for 3 days was significantly higher than that of the difference value of PA-I before the surgery and after the surgery for 3 days and the CRP after the surgery for 3 days(P<0.001).Set as cut-off value as 0.45 ng/L,the sensitivity was 91.18%,the specificity was 79.63%.CONCLUSION The early deep incision infection in the internal spinal fixation patients is closely associated with the Smad2 after the surgery for 3 days,the difference value of PAI-I before the surgery and after the surgery for 3 days,and the CRP level after the surgery for 3 days,which can be served as factors for prediction of the early deep incision infection.