经皮椎间孔镜髓核摘除术后椎间隙感染指标早期诊断价值分析

Analysis of early diagnostic values for indexes in spondylodiscitis follow percutaneous transforaminal lumbar discectomy

摘要:

目的：分析C反应蛋白（C-reactive protein, CRP）和中性粒细胞与淋巴细胞比值（neutrophil lymphocyte ratio, NLR）在经皮椎间孔镜下髓核摘除术（percutaneous transforaminal endoscopic discectomy, PTED）后的变化，以及二者在PTED后椎间隙感染（spondylodiscitis follow PTED, PTED-SD）中的早期诊断价值。方法：回顾性分析我院疼痛科PTED后非感染组（non-infectious group, NI组）和PTED-SD组的病历资料。记录患者术前，术后第1、3和第5天静脉血CRP，NLR和血沉的变化；比较NI组3个指标的围术期改变；利用PTED-SD组计算CRP和NLR的临界值。结果：共纳入110例NI组患者和8例PTED-SD组患者。NI组CRP迅速轻度升高，于术后第3天达峰值后开始下降，术后第5天仍高于术前水平（P﹤0.05）；NLR于术后第1天达峰值，于术后第5天恢复至术前水平；围术期血沉在正常范围内持续呈轻微上升趋势；术后第1天和第3天CRP和NLR临界值分别为12.52mg/L和4.40以及35.5mg/L和5.50，曲线下面积超过0.5。结论：CRP和NLR均较血沉反应迅速，两指标术后第1天和术后第3天临界值均对感染具有预测价值，对其动态变化的监测将更有助于PTED-SD的早期诊断。

Abstract:

Objective: To analyze the changes of C-reactive protein (CRP) and neutrophil lymphocyte ratio (NLR) after percutaneous transforaminal endoscopic discectomy (PTED), and their early diagnostic values for the spondylodiscitis follow PTED (PTED-SD). Methods: The medical records of non-infectious patients (NI group) after PTED and PTED-SD group in the pain department of our hospital were analyzed retrospectively. The changes of CRP, NLR, and erythrocyte sedimentation rate in venous blood before PTED, on the 1st, 3rd, and 5th day after PTED were recorded; The perioperative changes of three indexes in NI group were compared; The PTED-SD group were used to calculated the cut-off values of CRP and NLR. Results: A total of 110 patients in the NI group and 8 patients in the PTED-SD group were enrolled. The level of CRP in the NI group increased rapidly and slightly, peaked on the 3rd day after PTED, then began to decline, and was still higher than the preoperative level on the 5th day after PTED (P﹤0.05); NLR reached its peak on the 1st day after PTED, and recovered to the preoperative level on the 5th day after surgery; The erythrocyte sedimentation rate continued to increase slightly within the normal range during perioperative period. The cut-off values of CRP and NLR on the 1st and 3rd days after PTED were 12.52mg/L and 4.40 mg/L, 35.5mg/L and 5.50 mg/L, respectively. Their areas under the curves were more than 0.5. Conclusion: Compared with erythrocyte sedimentation rate, both CRP and NLR responded quickly. The cut-off values of the two indexes on the 1st and the 3rd day after PTED were of predictive significance. The monitoring of their dynamic changes will be more helpful to early diagnose the PTED-SD.