首页|老年胸腰椎压缩性骨折术后肺部感染病原菌及危险因素

老年胸腰椎压缩性骨折术后肺部感染病原菌及危险因素

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目的 分析老年胸腰椎压缩性骨折术后肺部感染的临床特征及危险因素。方法 将浙江省中医药大学附属江南医院2020年12月—2022年12月收治的317例老年胸腰椎压缩性骨折择期手术患者按是否存在肺部感染分为肺部感染组(n=80)、非感染组(n=237);比较两组临床特征及实验指标，Logistic逐步回归分析老年胸腰椎压缩性骨折患者肺部感染的影响因素并构建风险预测模型，绘制受试者工作特征(ROC)曲线分析模型预测价值。结果 两组体质量指数(BMI)、糖尿病、骨折节段≥3节、手术时间及手术时间＞2 h、术后引流管留置时间≥5 d、术前白蛋白比较差异有统计学意义(P＜0。05);肺部感染组白细胞介素(IL)-6、IL-17、IL-23、肿瘤坏死因子-α(TNF-α)、干扰素-γ(IFN-γ)高于非感染组，IL-2低于非感染组(P＜0。05);Logistic逐步回归分析显示IL-6、IL-23、TNF-α、IFN-γ是老年胸腰椎压缩性骨折患者肺部感染的危险因素(P＜0。05);老年胸腰椎压缩性骨折患者肺部感染的风险预测模型曲线下面积(AUC)为0。845，敏感度、特异度为80。00％、93。25％。结论 老年胸腰椎压缩性骨折患者血IL-6、IL-23、TNF-α、IFN-γ与肺部感染的发生密切相关，基于上述指标所构建的风险预测模型在预测此类患者肺部感染的发生上有着较高的特异度，值得临床重视。
Pathogens and risk factors for postoperative pulmonary infection in elderly patients with thoracolumbar vertebral compression fractures
OBJECTIVE To analyze the clinical characteristics and risk factors of postoperative pulmonary infection in elderly patients with thoracolumbar vertebral compression fractures.METHODS A total of 317 elderly patients who underwent elective surgery for thoracolumbar vertebral compression fracture in Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University between Dec 2020 and Dec 2022 were recruited and divided into the infec-tion group(n=80)and non-infection group(n=237)according to whether the pulmonary infection occurred.The clinical characteristics and laboratory indicators were compared between the two groups.Logistic regression analy-sis was performed to screen the influencing factors of pulmonary infection in elderly patients with thoracolumbar vertebral compression fracture and a risk prediction model was constructed.The predictive value of this model was analyzed by receiver operating characteristic(ROC)curve.RESULTS There were significant differences in body mass index(BMI),diabetes,fracture segment ≥3,operation time and operation time＞2 h,postoperative drain-age tube indwelling time ≥5 d,and preoperative albumin between the two groups(P＜0.05).The levels of inter-leukin(IL)-6,IL-17,IL-23,tumor necrosis factor-α(TNF-α)and interferon-γ(IFN-γ)were significantly high-er,while the level of IL-2 was significantly lower in the infection group than those in the non-infection group(P＜0.05).Logistic regression analysis found that IL-6,IL-23,TNF-α and IFN-γ were risk factors for pulmonary in-fection in elderly patients with thoracolumbar vertebral compression fracture(P＜0.05).The area under the curve(AUC)value of constructed risk prediction model for pulmonary infection in elderly patients with thoracolumbar vertebral compression fracture was 0.845.The sensitivity and specificity were 80.00％and 93.25％,respectively.CONCLUSION IL-6,IL-23,TNF-α and IFN-γ are closely related to pulmonary infection in elderly patients with thoracolumbar vertebral compression fracture.The risk prediction model constructed based on above indexes has high specificity in predicting pulmonary infection in such patients.

Thoracolumbar vertebral compression fractureElderlyPulmonary infectionPostoperative infectionPathogenRisk factorPrediction modelInterleukin-6Interleukin-23Tumor necrosis factor-αInterferon-γ

章金芬、杨玲娟、汤样华、胡文跃、张范华

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浙江省中医药大学附属江南医院消毒供应中心,浙江杭州 311201

浙江省中医药大学附属江南医院第六病区,浙江杭州 311201

浙江省中医药大学附属江南医院第九病区,浙江杭州 311201

浙江省中医药大学附属江南医院检验科,浙江杭州 311201

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胸腰椎压缩性骨折 老年 肺部感染 术后感染 病原菌 危险因素 预测模型 白细胞介素-6 白细胞介素-23 肿瘤坏死因子-α 干扰素-γ

浙江省医药卫生科学研究基金

2021KY482

2024

10.11816/cn.ni.2024-231006

中华医院感染学杂志
中华预防医学会 中国人民解放军总医院

中华医院感染学杂志

CSTPCD北大核心
影响因子：1.885
ISSN：1005-4529
年,卷(期)：2024.34(8)
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