C反应蛋白在下行性坏死性纵隔炎中的预警作用

目的: 探讨口腔颌面颈部多间隙感染继发下行性坏死性纵隔炎（descending necrotizing mediastinitis,DNM）的危险因素,为DNM的早期诊断和早期治疗提供依据。方法: 收集2016年12月—2017年12月于上海交通大学医学院附属第九人民医院口腔外科急诊首诊的口腔颌面颈部多间隙感染患者的一般资料,包括感染来源、实验室检查、是否发生DNM及治疗结果等。根据是否发生DNM,将患者分为2组,采用SPSS 22.0软件包对2组中连续型变量进行t检验或t'检验,二分类变量及等级变量进行Fisher 精确检验。结果: 201例口腔颌面颈部多间隙感染患者中,继发DNM 14例,发生率为6.97%。201例患者中,男142 例,女59例;平均年龄（52.98±17.12）岁。最常见的原发疾病为根尖周炎（90例）,占44.8%,其次为智牙冠周炎（50例,24.9%）;发病源的最常受累部位为下颌后牙区,为140例（69.7%）。单因素分析显示,发病部位（P<0.001）、中性粒细胞百分比（P=0.004）、C反应蛋白（P<0.001）均为DNM的危险因素。结论: 对于C反应蛋白较高的口腔颌面颈部多间隙感染患者,要高度怀疑发生DNM的可能。

Early-warning function of C-reactive protein in diagnosis of descending necrotic mediastinitis

PURPOSE: The aim of this study was to compare clinical information of patients suffering from oral and maxillofacial multiple space infection patients with or without descending necrotic mediastinitis (DNM), to analyze the risk factors for DNM, so as to provide clinical support for early diagnosis and treatment of descending necrotic mediastinitis. METHODS: This study was a prospective cohort study. The patients with severe oral and maxillofacial and cervical multiple space infections who were referred to the Department of Oral Surgery at Shanghai Ninth People's Hospital, Shanghai Jiao Tong Tong University School of Medicine from December 2016 to December 2017 were included. The clinical data were recorded, such as gender, age, source of original infection, laboratory test, occurrence of DNM. According to whether DNM occurred, the patients were divided into two groups. Continuous variables were compared by t or t' test between the two groups, and discrete variables were analyzed with Fisher's exact test using SPSS 22.0 software package. RESULTS: Two hundred and one patients with oral and maxillofacial and cervical multiple space infection during 12 months were enrolled. 14 patients developed DNM, and the occurrence was 6.97%. Among 201 patients, there were 142 males and 59 females. The average age of patients was 52.98±17.12 years. The most common causes were periapical periodontitis in 90 cases, accounting for 44.8%, followed by pericoronitis of wisdom teeth in 50 cases (24.9%). In addition, the most commonly site of primary source was mandibular posterior teeth in 140 cases (69.7%). After univariate analysis, the site of onset (P<0.001), neutrophil percentage (P=0.004), C-reactive protein (P<0.001) had significant relationship with DNM. CONCLUSIONS: Secondary DNM is more likely to occur in patients with high level of C-reactive protein and neutrophil percentage .