乙型肝炎病毒感染与脊柱内固定术后深部感染的相关性研究及病原菌分析

Correlation between hepatitis B virus infection and deep infection after spinal internal fixation surgery and analysis of pathogenic bacteria

目的探讨乙型肝炎病毒(HBV)感染与脊柱内固定术后深部感染的相关性及病原菌分析。方法选取2013年1月至2019年1月湖北省孝感市第一人民医院行脊柱内固定术且伴随HBV感染的患者184例作为HBV感染组,选取同期行脊柱内固定术的非HBV感染患者184例作为非HBV感染组。比较两组患者术后深部感染发生情况及其病原菌分布情况,采取单因素分析和多因素Logistics回归分析法分析HBV感染患者术后发生深部感染、HBV再激活的影响因素。结果HBV感染组患者术后深部感染发生率显著高于非HBV感染组[19.57%(36/184)比9.24%(17/184)],差异有统计学意义(P<0.01)。两组患者术后深部感染的病原菌均以鲍氏不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌、表皮葡萄球菌为主,病原菌分布情况比较差异无统计学意义(P>0.05)。年龄≥65岁、手术时间≥3 h、术中出血量≥1000 ml、CD4^(+)/CD8^(+)<1.4、总淋巴细胞计数<0.7×10^(9)/L、术前肝功能异常[天冬氨酸氨基转移酶(AST)>40 U/L或丙氨酸氨基转移酶(ALT)>50 U/L]、术前HBV-DNA(^(+))的HBV感染患者术后深部感染发生率均显著升高[27.16%(22/81)比13.59%(14/103)、28.77%(21/73)比13.51%(15/111)、31.15%(19/61)比13.82%(17/123)、29.69%(19/64)比14.17%(17/120)、27.78%(20/72)比14.29%(16/112)、7/18比17.47%(29/166)、30.43%(21/69)比13.04%(15/115)],差异均有统计学意义(P<0.05或<0.01)。多因素Logistic回归分析结果显示,术中出血量(≥1000 ml)、CD4^(+)/CD8^(+)(<1.4)、总淋巴细胞计数(<0.7×10^(9)/L)、术前HBV-DNA(^(+))是HBV感染患者脊柱内固定术后深部感染的独立危险因素(P<0.01或<0.05)。年龄≥65岁、手术时间≥3 h、术中出血量≥1000 ml、术前肝功能异常、术前HBV-DNA(^(+))、术后深部感染患者HBV再激活发生率显著升高[(33.33%(27/81)比18.45%(19/103)、34.25%(25/73)比18.92%(21/111)、34.43%(21/61)比20.33%(25/123)、8/18比22.89%(38/166)、34.78%(24/69)比19.13%(22/115)、41.67%(15/36)比20.95%(31/148)],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术中出血量(≥1000 ml)、术前HBV-DNA(^(+))、术后深部感染是HBV感染患者HBV再激活的独立危险因素(P<0.05或<0.01)。结论HBV感染显著增加脊柱固定术后深部感染发生率,其独立危险因素为术中出血量(≥1000 ml)、CD4^(+)/CD8^(+)(<1.4)、总淋巴细胞计数(<0.7×10^(9)/L)、术前HBV-DNA(^(+))。脊柱内固定术可引起HBV再激活,其独立危险因素为术中出血量(≥1000 ml)、术前HBV-DNA(^(+))、术后深部感染。

Objective To explore the correlation between hepatitis B virus(HBV)infection and deep infection after spinal internal fixation surgery and analysis of pathogenic bacteria.Methods One hundred and eighty-four patients who underwent spinal internal fixation with HBV infection in Xiaogan First People′s Hospital of Hubei Province from January 2013 to January 2019 were selected as the HBV infection group,and 184 patients who underwent spinal internal fixation with non-HBV infection were selected as the non-HBV infection group.The incidence of deep infection and the distribution of pathogenic bacteria were compared between 2 groups.The influencing factors of postoperative deep infection and HBV reactivation in patients with HBV infection were analyzed by single factor analysis and multi-factor Logistics regression analysis.Results The incidence of deep infection after spinal internal fixation surgery in HBV infection group was significantly higher than that in non-HBV infection group:19.57%(36/184)vs.9.24%(17/184),and there was statistical difference(P<0.01).The pathogenic bacteria of deep infection in both groups were mainly acinetobacter bausinensis,klebsiella pneumoniae,staphylococcus aureus,staphylococcus epidermidis.There was no statistically significant difference in the distribution of pathogenic bacteria between 2 groups(P>0.05).The deep infection incidences in age≥65 years,operation time≥3 h,intraoperative blood loss≥1000 ml,CD4^(+)/CD8^(+)<1.4,total lymphocyte count<0.7×10^(9)/L,liver function abnormalities(AST>40 U/L or ALT>50 U/L),HBV-DNA(^(+))patients with HBV infection were significantly higher:27.16%(22/81)vs.13.59%(14/103),28.77%(21/73)vs.13.51%(15/111),31.15%(19/61)vs.13.82%(17/123),29.69%(19/64)vs.14.17%(17/120),27.78%(20/72)vs.14.29%(16/112),7/18 vs.17.47%(29/166),30.43%(21/69)vs.13.04%(15/115),and there were statistical differences(P<0.05 or<0.01).Multivariate Logistic regression analysis showed that intraoperative blood loss(≥1000 ml),CD4^(+)/CD8^(+)(<1.4),total lymphocyte count(<0.7×10^(9)/L),and HBV-DNA(^(+))were independent risk factors for deep infection after spinal internal fixation in patients with HBV infection(P<0.01 or<0.05).The HBV reactivation incidence in age≥65 years,operation time≥3 h,intraoperative blood loss≥1000 ml,liver function abnormalities,HBV-DNA(^(+)),postoperative deep infection patients with HBV infection were significantly increased:33.33%(27/81)vs.18.45%(19/103),34.25%(25/73)vs.18.92%(21/111),34.43%(21/61)vs.20.33%(25/123),8/18 vs.22.89%(38/166),34.78%(24/69)vs.19.13%(22/115),41.67%(15/36)vs.20.95%(31/148),and there were statistical differences(P<0.05).Multivariate Logistic regression analysis showed that intraoperative blood loss(≥1000 ml),HBV-DNA(^(+))and postoperative deep infection were independent risk factors for HBV reactivation after spinal internal fixation in patients with HBV infection(P<0.05 or<0.01).Conclusions HBV infection significantly increases the incidence of deep infection after spinal internal fixation surgery,and the independent risk factors are intraoperative blood loss(≥1000 ml),CD4^(+)/CD8^(+)(<1.4),total lymphocyte count(<0.7×10^(9)/L),and HBV-DNA(^(+)).Spinal internal fixation surgery can cause HBV reactivation,and its independent risk factors are intraoperative blood loss(≥1000 ml),HBV-DNA(^(+))and postoperative deep infection.