Clinical Application Of RDW Combined With T-SPOT.TB In Differential Diagnosis Of Spinal Infection

Objective: To investigate the clinical value of the red blood cell distribution width(RDW)combined with T-SPOT.TB assay in differential diagnosis of spinal infection.Methods: The inpatient data of 1036 patients with spinal infection who underwent surgery in our hospital from January 2011 to December 2021 and had clear postoperative pathological results were retrospectively analyzed.Among them,270 patients had clear pathological results and met the inclusion criteria.According to the pathological diagnosis,the patients were divided into group A: Pyogenic spondylitis;Group B: Tuberculosis spondylitis.Data collected include: demographic characteristics(gender,age,weight,etc.);Admission laboratory examination(RDW,ESR,C-RP,WBC,T-SPOT.TB,percentage of neutrophils,etc.).Through t-test,univariate logistic analysis,multivariate logistic analysis and other statistical methods,the contents of the appeal study and observation indexes were analyzed,the differences between the two groups were compared,the boundary values of red blood cell distribution width and other indexes in the diagnosis of pyogenic spondylitis were analyzed by subject working characteristic curve.Chi-square test was used to compare the diagnostic efficacy of T-SPOT.TB and T-SPOT.TB combined with RDV-CV in the diagnosis of tuberculous spondylitis.Results: 270 patients with definite pathological results and meeting inclusion criteria,148 males and 122 females,with an average age of 56.60 years.The results showed that there were significant differences in average age,RDW,total plasma protein,percentage of neutrophils,absolute value and percentage of monocytes between pyogenic spondylitis and tuberculous spondylitis(P<0.05).Univariate logistic analysis indicated that age and RDW-CV were protective factors for tuberculous spondylitis compared with pyogenic spondylitis(OR<1,P<0.05).Multivariate logistic regression analysis showed that RDW was the protective factors of tuberculous spondylitis(OR<1,P<0.05);Compared with pyogenic spondylitis,monocyte percentage and percentage of neutrophils were the risk factors of tuberculous spondylitis(OR>1,P<0.05).By plotting the ROC curve of RDW,the area under the curve is 65.6%,and when the RDW value is >13.85,the sensitivity and specificity for the diagnosis of pyogenic spondylitis in patients with spinal infection are 50.7% and 76.5%(95%CI 0.589~0.722,P<0.001).The sensitivity and specificity of T-SPOT.TB for tuberculous spondylitis were 86.76% and 89.55%,respectively.And the diagnostic index was 176.31%.The sensitivity and specificity of T-SPOT.TB+RDV-CV in the diagnosis of tuberculous spondylitis were 100% and 95.55%,respectively.And the diagnostic index was 195.55%.T-SPOT.TB +RDW-CV was higher than that of T-SPOT.TB alone,and there was statistical difference in diagnostic index between the two groups(P<0.05).Conclusion: RDW is of great value in differentiating pyogenic spondylitis from tuberculous spondylitis;RDW-CV combined with T-SPOT.TB can improve the diagnostic efficiency of differentiating tuberculous spondylitis from suppurative spondylitis in patients with spinal infection,which provides a new perspective for the differential diagnosis of pyogenic spondylitis and tuberculous spondylitis.