C-反应蛋白/白蛋白比和中性粒/淋巴比预测脊柱术后感染

The C-Reactive Protein/Albumin Ratio and Neutrophil/Lymphocyte Ratio Predicted Postoperative Spinal Infection

摘要: 目的：本研究旨在分析中性粒细胞与淋巴细胞比值(NLR)与C-反应蛋白/白蛋白比值(CRP/ALB)联合应用在预测脊柱外科手术后感染风险中的临床价值。方法：本研究为回顾性分析，选取2020年1月至2023年12月期间在本院行脊柱手术的患者共200例。依据术后是否发生感染，将患者分为感染组(n = 50)与未感染组(n = 150)。收集并比较两组患者的临床资料，包括性别、年龄、体重指数(BMI)、基础疾病史(如高血压、糖尿病、冠心病)、生活习惯(吸烟、饮酒情况)、手术相关因素(手术时长、手术部位、是否使用内固定、术中是否输血)，以及术后炎症相关指标(NLR、CRP、ALB)。首先对以上各项因素进行单因素分析，筛选出差异具有统计学意义的变量(P < 0.05)，随后将这些变量纳入多因素Logistic回归模型，以进一步明确导致术后感染的独立危险因素。结果：单因素分析结果表明，年龄、糖尿病病史、手术时间、术中输血、是否使用内固定、术后NLR水平及术后CRP/ALB比值均与术后感染的发生存在显著相关性(P均 < 0.05)。进一步的多因素Logistic回归分析显示，以下因素为脊柱手术后感染的独立危险因素：年龄 [OR = 1.090, 95%CI (1.051~1.130), P < 0.001]；糖尿病[OR = 2.568, 95%CI (1.103~5.979), P = 0.029]；手术时间[OR = 1.016, 95%CI (1.008~1.025), P < 0.001]；使用内固定[OR = 11.000, 95%CI (3.646~33.180), P < 0.001]；术后NLR [OR = 3.502, 95%CI (2.184~5.616), P < 0.001]；术后CRP/ALB比值[OR = 2.038, 95%CI (1.486~2.795), P < 0.001]；而术中输血因素在多因素分析中未显示出显著相关性(P = 0.111)。结论：患者年龄偏高、合并糖尿病、手术持续时间较长、术中使用内固定，以及术后NLR和CRP/ALB水平的升高，均为脊柱外科手术后并发感染的独立危险因素。其中，使用内固定(OR = 11.0)和术后NLR水平(OR = 3.5)是预测感染风险最为敏感和显著的指标。

Abstract: Objective: This study aimed to analyze the clinical value of the neutrophil-to-lymphocyte ratio (NLR) combined with C-reactive protein/albumin ratio (CRP/ALB) in predicting postoperative infection risk in spinal surgery. Methods: This retrospective analysis included 200 spinal surgery patients at our hospital between January 2020 and December 2023. Patients were divided into infection group (n = 50) and non-infection group (n = 150) based on postoperative infection status. Clinical data were collected and compared between groups, including gender, age, body mass index (BMI), underlying conditions (hypertension, diabetes, coronary heart disease), lifestyle habits (smoking, alcohol consumption), surgical factors (surgical duration, site, internal fixation use, intraoperative blood transfusion), and postoperative inflammatory markers (NLR, CRP, ALB). Univariate analysis identified statistically significant variables (P < 0.05), which were then incorporated into a multivariate logistic regression model to determine independent risk factors for postoperative infection. Results: Univariate analysis demonstrated significant correlations between age, diabetes history, surgical duration, intraoperative blood transfusion, internal fixation use, postoperative NLR levels, and CRP/ALB ratio with postoperative infection occurrence (P < 0.05). Further multivariate logistic regression analysis revealed the following independent risk factors for postoperative spinal infections: age [OR = 1.090, 95%CI (1.051~1.130), P < 0.001]; diabetes [OR = 2.568, 95%CI (1.103~5.979), P = 0.029]; operative duration [OR = 1.016, 95%CI (1.008~1.025), P < 0.001]; use of internal fixation [OR = 11.000, 95%CI (3.646~33.180), P < 0.001]; postoperative neutrophil-to-lymphocyte ratio (NLR) [OR = 3.502, 95%CI (2.184~5.616), P < 0.001]; postoperative C-reactive protein (CRP)/albumin (ALB) ratio [OR = 2.038, 95%CI (1.486~2.795), P < 0.001]. Intraoperative blood transfusion showed no significant correlation in the multivariate analysis (P = 0.111). Conclusion: Advanced patient age, diabetes comorbidity, prolonged operative duration, intraoperative use of internal fixation, and elevated postoperative NLR/CRP/ALB levels are independent risk factors for spinal surgery-related infections. Notably, the use of internal fixation (OR = 11.0) and postoperative NLR levels (OR = 3.5) were identified as the most sensitive and significant predictors of infection risk.