Effects and risk factors of diabetes and immunosuppressive state on surgical site deep infection after posterior lumbar interbody fusion surgery
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摘要:
目的 探究糖尿病(DM)和免疫抑制状态(IS)与腰椎后路融合术后深部组织感染(SSDI)的关系及相关危险因素，为SSDI防治提供依据。 方法 对2020年1月—2025年1月于内蒙古医科大学第二附属医院行腰椎后路融合术的350例患者临床资料进行回顾性分析。根据患者术前是否存在DM或(和)IS分为A组(单纯DM, 90例)、B组(单纯IS，46例)、C组(DM合并IS，30例)与D组(无DM且无IS，184例)。比较各组SSDI发生率；根据SSDI发生与否分组，通过单因素及多因素logistic回归分析研究SSDI发生的危险因素。 结果 患者术后SSDI发生率为7.43%(26/350)，病原菌共检出35株，其中金黄色葡萄球菌占比60.00%(21/35)。A组、B组、C组、D组术后SSDI发生率分别为8.89%、10.87%、20.00%、3.80%，且C组显著高于D组(χ2=11.858，P＜0.008)。多因素logistic回归分析显示，术前DM合并IS(OR=4.600，95% CI：1.912~11.068)、术前糖化血红蛋白(HbA1c)水平(OR=3.456，95% CI：1.654~7.221)及术后引流时间(OR=1.430，95% CI：1.058~1.934)均是术后SSDI发生的独立影响因素(P＜0.05)。 结论 DM与IS是腰椎后路融合术后SSDI发生的重要危险因素。 Abstract:Objective To explore the relationship between diabetes (DM) and immunosuppressive state (IS) with deep surgical site infection (SSDI) after posterior lumbar fusion surgery, and to identify the related risk factors, in order to provide basis for the prevention and treatment of SSDI. Methods A retrospective analysis was conducted on the clinical data of 350 patients who underwent PLIF surgery in the Second Affiliated Hospital of Inner Mongolia Medical University from January 2020 to January 2025. According to whether patients had DM or (and) IS before the operation, the patients were divided into four groups: group A (n=90, DM), group B (n=46, IS), DM combined with IS (n=30, DM and IS), and No DM and no IS (n=184, neither DM nor IS). The incidence of SSDI in each group was compared, and they were grouped according to the presence or absence of SSDI. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for SSDI occurrence. Results The incidence of SSDI after surgery was 7.43% in the patients. A total of 35 pathogenic bacteria were detected, among which Staphylococcus aureus accounted for 60.00% (21/35). The incidences of SSDI after surgery in group A, group B, group C, and group D were 8.89%, 10.87%, 20.00%, and 3.80% respectively, and those in group C was significantly higher than that in group D (chi-square value, χ2=11.858, P < 0.008). Multivariate logistic regression analysis revealed that preoperative DM combined with IS (OR=4.600, 95% CI: 1.912-11.068), preoperative HbA1c level (OR=3.456, 95% CI: 1.654-7.221), and postoperative drainage time (OR=1.430, 95% CI: 1.058-1.934) were independent influencing factors for the occurrence of SSDI after surgery (P < 0.05). Conclusion DM and IS are important co-occurring risk factors for SSDI after PLIF surgery. -
表 1 4组腰椎后路融合术患者一般资料比较
Table 1. Comparison of general information of four groups of patients undergoing posterior lumbar fusion surgery
项目 A组(n=90) B组(n=46) C组(n=30) D组(n=184) 统计量 P值 年龄[例(%)] 3.327a 0.344 ≥60岁 40(44.44) 18(39.13) 16(53.33) 69(37.50) ＜60岁 50(55.56) 28(60.87) 14(46.67) 115(62.50) 性别[例(%)] 0.546a 0.909 男性 50(55.56) 24(52.17) 17(56.67) 95(51.63) 女性 40(44.44) 22(47.83) 13(43.33) 89(48.37) BMI[例(%)] 3.691a 0.297 ≥25 47(52.22) 21(45.65) 17(56.67) 78(42.39) ＜25 43(47.78) 25(54.35) 13(43.33) 106(57.61) 术前HbA1c(x±s, %) 7.30±1.64 5.50±0.68 7.82±1.78 5.41±0.56 90.824b ＜0.001 手术节段[例(%)] 0.569a 0.997 单节段 52(57.78) 29(63.04) 18(60.00) 112(60.87) 双节段 30(33.33) 14(30.43) 10(33.33) 58(31.52) ≥三节段 8(8.89) 3(6.52) 2(6.67) 14(7.61) 手术时间(x±s, min) 178.63±46.75 176.90±45.18 182.37±48.00 172.16±44.18 0.719b 0.541 术中失血量(x±s, mL) 370.15±56.80 358.84±55.34 380.00±57.63 359.75±55.96 1.647b 0.178 术前CRP(x±s, mg/L) 4.12±0.84 4.00±0.90 4.21±1.35 3.89±0.68 2.347b 0.073 术前Hb(x±s, g/L) 131.80±16.16 130.48±15.98 128.96±16.22 133.25±15.47 0.893b 0.445 术前Alb(x±s, g/L) 36.78±4.25 37.02±4.00 36.10±4.43 37.75±4.10 2.084b 0.102 注：a为χ2值，b为F值。 
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表 2 4组腰椎后路融合术患者术后SSDI发生率比较
Table 2. Comparison of SSDI incidence rates after surgery among the four groups of patients undergoing posterior lumbar fusion surgery
组别 例数 SSDI[例(%)] A组 90 8(8.89) B组 46 5(10.87) C组 30 6(20.00)a D组 184 7(3.80) χ2值 11.480 P值 0.009 注：两两比较校正检验水准α’=0.008；与D组比较，aP＜0.008。
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表 3 腰椎后路融合术患者术后SSDI发生影响因素的单因素分析
Table 3. Univariate analysis of influencing factors for SSDI occurrence in patients after posterior lumbar fusion surgery
项目 SSDI组
(n=26)非SSDI组
(n=324)统计量 P值 年龄[例(%)] 1.961a 0.161 ≥60岁 14(53.85) 129(39.81) ＜60岁 12(46.15) 195(60.19) 性别[例(%)] 0.233a 0.629 男性 15(57.69) 171(52.78) 女性 11(42.31) 153(47.22) BMI[例(%)] 1.396a 0.237 ≥25 15(57.59) 148(45.68) ＜25 11(42.31) 176(54.32) 术前状态[例(%)] 11.480a 0.009 A 8(30.77) 82(25.31) B 5(19.23) 41(12.65) C 6(23.08) 24(7.41) D 7(26.92) 177(54.63) 术前HbA1c(x±s，%) 7.96±1.82 5.97±0.86 10.154b ＜0.001 IS具体原因[例(%)] 1.074a 0.898 糖皮质激素应用 7(63.64) 33(50.77) 免疫抑制剂应用 3(27.27) 21(32.31) 器官移植术后 1(9.09) 7(10.77) 血液系统恶性肿瘤 0 2(3.08) 获得性免疫缺陷综合征 0 2(3.08) ASA分级[例(%)] 4.220a 0.040 Ⅰ~Ⅱ级 15(57.59) 246(75.93) Ⅲ级 11(42.31) 78(24.07) 手术节段[例(%)] 6.701a 0.035 单节段 11(42.31) 200(61.73) 双节段 10(38.46) 102(31.48) ≥三节段 5(19.23) 22(6.79) 手术时间(x±s，min) 185.00±46.83 174.55±45.30 1.129b 0.260 术中失血量(x±s，mL) 380.26±56.47 362.74±56.13 1.151b 0.127 术后引流时间(x±s，d) 3.45±1.00 2.00±0.64 10.581b ＜0.001 术前CRP(x±s，mg/L) 4.15±1.00 3.98±0.96 0.866b 0.387 术前Hb(x±s，g/L) 129.12±16.00 132.39±16.18 0.992b 0.322 术前Alb(x±s，g/L) 35.45±4.16 37.41±4.22 2.281b 0.023 注：IS具体原因患者分布比例即例数/SSDI组或非SSDI组IS患者例数(分别为11例与65例)×100%。术前状态，A为单纯DM，B为单纯IS，C为DM合并IS，D为无DM且无IS。a为χ2值，b为t值。
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表 4 腰椎后路融合术患者术后SSDI发生影响因素的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of influencing factors for SSDI occurrence in patients after posterior lumbar fusion surgery
变量 B SE Waldχ2 P值 OR值 95% CI 术前DM合并IS 1.526 0.448 11.603 0.001 4.600 1.912~11.068 术前HbA1c 1.240 0.376 10.876 0.001 3.456 1.654~7.221 术后引流时间 0.358 0.154 5.404 0.021 1.430 1.058~1.934 注：本表仅列出差异有统计学意义的变量。各变量赋值如下，术前DM合并IS(是=1，否=0)；术前HbA1c、术后引流时间均为连续变量，以实际值赋值。
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