妇科术后早期感染影响因素及miR-146a、NLR和CRP/ALB的诊断价值

Influencing factors for postoperative early infections in gynecology department patients and diagnostic values of miR-146a,NLR and CRP/ALB ratio

目的探究妇科术后早期感染影响因素,分析微小核糖核酸(miR)-146a、中性粒细胞与淋巴细胞比值(NLR)和C-反应蛋白/白蛋白(CRP/ALB)比值的临床价值.方法选择2018年2月-2021年4月在广州花都时代妇产医院接受妇科手术的1302例患者,根据术后病原学检查结果分为感染组60例和未感染组1242例,分析病原菌分布特点,筛选妇科手术患者早期感染影响因素,评估miR-146a、NLR和CRP/ALB比值的诊断价值.结果1302例妇科手术患者术后早期感染60例,感染率为4.61%,感染部位占比较高的分别为呼吸道、泌尿道、生殖道;共分离98株病原菌,革兰阴性菌54株占55.10%,革兰阳性菌41株占41.84%,真菌3株占3.06%;手术类型、侵入性操作是妇科手术患者术后感染的影响因素(P<0.05);感染组患者miR-146a、NLR、CRP/ALB表达水平均高于未感染组(P<0.05);受试者工作特征(ROC)曲线显示miR-146a、NLR和CRP/ALB比值均对妇科手术患者术后感染有较高诊断价值,三者联合诊断曲线下面积(AUC)为0.955,敏感度和特异度分别86.67%和92.50%.结论妇科手术患者术后感染多发生于呼吸道,病原菌以革兰阴性菌为主,miR-146a、NLR和CRP/ALB比值检测可作为妇科手术术后早期感染的辅助指标,三者联合诊断的效能更高.

OBJECTIVE To explore the influencing factors for postoperative early infection in the gynecology department patients and analyze the clinical values of micro ribonucleic acid-146a(miR-146a),neutrophil to lymphocyte ratio(NLR)and C-reactive protein to albumin(CRP/ALB)ratio.METHODS A total of 1302 patients who underwent gynecological surgeries in Guangzhou Huadu Times Maternity Hospital from Feb 2018 to Apr 2021 were enrolled in the study and were divided into the infection group with 60 cases and the no infection group according to the result of postoperative etiological test.The distribution of pathogens was observed,the influencing factors for the early infection were screened out,and the diagnostic values of miR-146a,NLR and CRP/ALB were evaluated.RESULTS Among the 1302 patients who underwent gynecological surgeries,60 had postoperative early infection,with the infection rate 4.61%.The patients who had respiratory tract infection,urinary tract infection and genital tract infection were dominant among the patients with the postoperative early infections.Totally 98 strains of pathogens were isolated,54(55.10%)of which were gram-negative bacteria,41(41.84%)were gram-positive bacteria,and 3(3.06%)were fungi.The types of surgery and invasive operation were the influencing factors for the postoperative infection in the gynecology department patient(P<0.05).The expression levels of miR-146a,NLR and CRP/ALB of the infection group were higher than those of the no infection group(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the miR-146a,NLR and CRP/ALB ratio had high values in diagnosis of postoperative infection in the gynecology department patients,the area under curve(AUC)of the joint detection of the three indexes was 0.955,with the sensitivity 86.67%,the specificity 92.50%..CONCLUSION The patients with respiratory tract infection are dominant among the gynecology department patients with postoperative infection.The gram-negative bacteria are the predominant pathogens.The miR-146a,NLR and CRP/ALB ratio can be used as auxiliary indexes for diagnosis of the postoperative early infection,and the efficiency of the joint detection of the three indexes is higher.