血清人防御素-3、白细胞介素-12与股骨颈骨折患者髋关节置换术后感染的相关性

The correlation between serum humanβ-defensin 3 and interleukin-12 levels and postoperative infection in hip replacement patients with femoral neck fractures

目的探讨股骨颈骨折(FNF)患者髋关节置换术后假体周围感染与术前血清人防御素-3(HBd-3)、白细胞介素-12(IL-12)水平的关系。方法采用前瞻性研究的方法,选取2020年4月至2022年4月在承德市中心医院接受髋关节置换术治疗的268例股骨颈骨折患者,依据术后2周内患者是否发生假体周围感染将其分为感染组与未感染组,比较两组基线资料、术前实验室指标,重点分析术前血清HBd-3、IL-12水平与患者术后假体周围感染的关系。结果268例股骨颈骨折患者髋关节置换术后发生假体周围感染17例,感染率为6.34%(17/268);感染组患者体质量指数、手术时间、术后引流时间、IL-12高于未感染组[(23.75±2.18)kg/m^(2)比(21.86±1.95)kg/m^(2)、(124.82±15.93)min比(116.92±14.75)min、(57.41±7.81)min比(49.65±5.73)min、(64.82±11.59)ng/L比(54.23±9.55)ng/L],术前白蛋白、HBd-3低于未感染组[(32.56±4.63)g/L比(37.25±5.81)g/L、(38.03±6.74)μg/L比(46.84±8.93)μg/L],差异有统计学意义(P<0.05);经Logistic回归分析结果显示,体质量指数高、手术时间与术后引流时间长、术前IL-12水平高是股骨颈骨折患者髋关节置换术后假体周围感染的危险因素(OR>1,P<0.05),术前血清白蛋白、HBd-3水平高是保护因素(OR<1,P<0.05);受试者工作特征曲线分析结果显示,术前血清HBd-3、IL-12单独及联合预测股骨颈骨折患者髋关节置换术后假体周围感染的曲线下面积>0.70,具有一定的预测价值;采用样条函数与Logistic回归结合的限制性立方样条法分析结果显示,HBd-3、IL-12水平与股骨颈骨折患者髋关节置换术后假体周围感染的关联强度呈线性剂量反应关系(P<0.05)。结论术前血清HBd-3、IL-12水平与股骨颈骨折患者髋关节置换术后发生假体周围感染有关,且可作为发生感染的预测指标。

Objective To explore the relationship between periprosthetic infection and preoperative serum levels of humanβ-defensin 3(HBd-3)and interleukin-12(IL-12)in patients with femoral neck fracture after hip replacement surgery.Methods A prospective study was conducted to 268 patients with femoral neck fracture who underwent hip replacement surgery at Chengde Central Hospital from April 2020 to April 2022.They were divided into an infected group and an uninfected group based on whether they had periprosthetic infection within 2 weeks after surgery.The baseline data and preoperative laboratory indicators of the two groups were compared,and the relationship between preoperative serum HBd-3 and IL-12 levels and postoperative periprosthetic infection in patients was mainly analyzed.Results Seventeen out of 268 patients with femoral neck fractures experienced periprosthetic infections after hip replacement surgery,with an infection rate of 6.34%(17/268).The body mass index,operation time,postoperative drainage time and IL-12 in the infected group were higher than those in the uninfected group:(23.75±2.18)kg/m^(2) vs.(21.86±1.95)kg/m^(2),(124.82±15.93)min vs.(116.92±14.75)min,(57.41±7.81)min vs.(49.65±5.73)min,(64.82±11.59)ng/L vs.(54.23±9.55)ng/L,the preoperative albumin and HBd-3 were lower than those in the uninfected group:(32.56±4.63)g/L vs.(37.25±5.81)g/L,(38.03±6.74)μg/L vs.(46.84±8.93)μg/L,and the differences were statistically significant(P<0.05).The results of Logistic regression analysis showed that high body mass index,long surgical and postoperative drainage time,and high preoperative IL-12 levels were risk factors for periprosthetic infection after hip replacement surgery in patients with femoral neck fractures(OR>1,P<0.05),while preoperative serum albumin and HBd-3 levels were protective factors(OR<1,P<0.05).Receiver operating characteristic curve results showed that preoperative serum HBd-3 and IL-12 alone and in combination predict AUC>0.70 for periprosthetic infection in patients with femoral neck fracture after hip replacement surgery,which had certain predictive value.The restricted cubic spline method combining spline function and Logistic regression was used for analysis,and the results showed a linear dose-response relationship between the levels of HBd-3 and IL-12 and the strength of the association with periprosthetic infection after hip replacement surgery in patients with femoral neck fracture(P<0.05).Conclusions Preoperative serum HBd-3 and IL-12 levels are associated with periprosthetic infection in patients with femoral neck fracture after hip replacement surgery,and can serve as predictive indicators for infection occurrence.