血清NLR、TLR2、CRP/ALB水平与股骨颈骨折术后感染相关性及临床预测价值分析

Study of potentiality of serum NLR,TLR2,and CRP/ALB levels in prediction of infection in patients of femoral and tibial fractures

目的研究中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte Ratio,NLR)、Toll样受体-2(TLR2)及C反应蛋白/白蛋白(CRP/ALB)水平与股骨颈骨折术后感染的相关性,并分析其在预测股骨颈骨折术后感染中的临床价值。方法选取内蒙古医科大学第二附属医院2018.06-2021.06股骨颈骨折手术279例,根据术后感染情况分为感染组(n=30)和非感染组(n=249),同期60例健康体检合格者纳为对照组,分别在股骨颈骨折患者术后d1及对照组入组后,采集被研究者外周静脉血,电阻法检测NLR水平,酶联免疫吸附法检测TLR2以及CRP/ALB水平。分别比较各组NLR、TLR2以及CRP/ALB水平。先后行单因素及多因素Logistic回归分析,分析影响股骨颈骨折术后感染的独立危险因素。绘制受试者工作特征曲线(ROC),分析术后1 d NLR、TLR2、CRP/ALB水平在预测骨折术后感染中的价值。结果股骨颈骨折患者术后1 d NLR、TLR2、CRP/ALB水平均高于对照组,差异均具有统计学意义(P<0.001)。感染组术后d1 NLR、TLR2、CRP/ALB水平均高于非感染组,差异均具有统计学意义(P<0.05)。多因素回归分析发现,术前贫血、围术期异体输血、手术时间以及术后1 d NLR、TLR2以及CRP/ALB水平是影响股骨颈骨折术后感染的独立因素。绘制ROC曲线发现,术后1 d NLR、TLR2、CRP/ALB单独应用,在预测股骨颈骨折术后感染中,以CRP/ALB最高,其AUC=0.888,95%CI为(0.811~0.964),三指标联合应用则可提高各指标单独应用时效能,其AUC=0.900,95%CI为(0.825~0.975)。结论股骨颈骨折术后1 d外周血NLR、TLR2、CRP/ALB水平异常升高是股骨颈骨折患者术后手术部位感染的独立危险因素,并在预测股骨颈骨折术后感染中具有一定的价值。

Objective To investigate the potentiality of serum neutrophil/lymphocyte ratio(NLR),Toll-like receptor 2(TLR2),and C-reactive protein/albumin(CRP/ALB)levels in prediction of infection in patients of femoral and tibial fractures.Methods According to the postoperative infection,279 cases of femoral neck fracture were divided into infection group(n=30)and non-infection group(n=249).Another 60 healthy individuals were set as control group.The peripheral venous blood samples were collected 1 day after surgery in the observation group and were collected immediately after admission in the control group.NLR was detected by electrical resistance method,and the levels of TLR2 and CRP/ALB were detected by enzyme-linked immunosorbent assay.These three indicators were compared between the three groups.Univariate and multivariate Logistic regression analysis were performed to screen the independent risk factors affecting postoperative infection in patients with femoral and tibial fractures.Moreover,receiver operating characteristic(ROC)curve was used to evaluate the ability of NLR,TLR2 and CRP/ALB levels at postoperative1d in predicting postoperative infection.Results The levels of NLR,TLR2 and CRP/ALB at postoperative 1d were abnormally elevated in the observation group compared with the control group(P<0.001).The levels of NLR,TLR2and CRP/ALB at postoperative 1d were remarkably increased in infection the group compared with the non-infection group(P<0.05).Multivariate logistic regression analysis showed that preoperative anemia,perioperative allogeneic transfusion,operative time,and the levels of NLR,TLR2,and CRP/ALB at postoperative 1d were independent factors of postoperative infection.In predicating the postoperative infection in patients underwent surgery,ROC curve denoted that CRP/ALB had the highest efficacy among the three indicators,with an AUC of 0.888[95CI%(0.811~0.964)]Combination of the NLR,TLR2,and CRP/ALB at postoperative 1d achieved better predictive efficacy than each of them with an AUC of 0.900[95CI%(0.825~0.975)].Conclusion Abnormal elevation of NLR,TLR2 and CRP/ALB in peripheral blood at postoperative 1d are independent risk factors for postoperative surgical site infection in patients with femoral and tibial fractures,and the combination of them had better predicting ability.