目的

总结66例坏死性筋膜炎（NF）患者的临床特征并分析其预后影响因素。

方法

回顾性分析2017 年1 月至2023 年12 月柳州市工人医院创伤修复烧伤整形外科收治的66 例NF 患者临床资料，总结NF 的临床特征。 比较预后良好和预后不良患者之间各临床因素的差异，筛选NF 患者预后不良的独立危险因素。 绘制受试者工作特征（ROC）曲线，评价可能的独立危险因素对NF 预后不良的预测价值。

结果

66 例NF 患者中男52 例，女14 例，男女比例为3.71 ∶1，年龄（55.98±13.71）岁，50～70 岁患者占59.09%，少数民族患者占53.03%，住院时间为40.50（27.75，55.00）d，医疗费用79 976.00（60 676.75，122 300.25）元。 创面主要位于下肢（84.85%），致病因素以糖尿病为主（59.09%），截肢率为15.15%，死亡率为3.03%。 创面共培养出77 株细菌，肺炎克雷伯菌为最常见细菌（16.88%），耐药菌株占22.08%。 坏死性筋膜炎实验室风险指数（LRINEC）评分为8.00（5.75，9.00）分，炎症扩散范围（ISR）评分为1（1，2）分。 预后不良患者LRINEC 评分明显高于预后良好患者（Z=-2.341，P=0.019），LRINEC 评分是NF 患者预后不良的独立危险因素（OR=1.373，95% CI：1.022～1.844，P=0.035）。 LRINEC 评分预测NF 发生预后不良的曲线下面积为0.723（95%CI：0.546 ～0.900，P=0.020），最佳截断点为7.5 分，敏感度、特异性分别为81.8%、54.5%。

结论

合并糖尿病的中老年男性为NF 的易感人群，该病好发于下肢，以肺炎克雷伯菌感染多见。 LRINEC 评分为NF 患者预后不良的独立危险因素，对NF 发生不良预后有一定的预测价值，LRINEC 评分≥7.5 提示NF 患者预后不良。

Objective

To summarize the clinical characteristics of 66 patients with necrotizing fasciitis （NF） and analyze the factors influencing prognosis.

Methods

A retrospective analysis was performed on the clinical data of 66 NF patients admitted to the Department of Trauma Repair， Burns and Plastic Surgery， Liuzhou Workers' Hospital from January 2017 to December 2023 to summarize the disease characteristics.Clinical factors between the patients with good and poor prognosis were compared， identifed independent risk factors for poor prognosis in NF patients.ROC curves were plotted to evaluate the predictive value of potential independent risk factors for poor prognosis in NF.

Results

Among the 66 patients with NF， there were 52 males and 14 females， with a male-to-female ratio of 3.71 ∶1， the average age was（55.98±13.71） years， patients aged 50 to 70 years accounted for 59.09%， ethnic minority patients account for 53.03%， the average hospital stay was 40.50 （27.75，55.00） days， and the medical costs was 79 976.00（60 676.75， 122 300.25） yuan.The majority of wounds were located in the lower limbs （84.85%）.Diabetes was the main pathogenic factor （59.09%）， the amputation rate was 15.15% and the mortality rate was 3.03%.A total of 77 bacterial strains were cultured from the wounds， with Klebsiella pneumoniae being the most common （16.88%）， and drug-resistant strains accounting for 22.08%.The laboratory risk indicator for necrotizing fasciitis （LRINEC） score was 8.00 （5.75，9.00）， and the inflammation spread range （ISR）score was 1 （1，2）.The LRINEC score in the poor prognosis patients was significantly higher than that in the good prognosis patients （Z=-2.341， P=0.019）， and LRINEC score was an independent risk factor for poor prognosis in NF patients （OR=1.373， 95%CI：1.022-1.844， P=0.035）.The ROC curve showed that the area under the curve for LRINEC score predicting poor prognosis in NF was 0.723 （95%CI：0.546-0.900，P=0.020）.The optimal cutoff value was 7.5， with a sensitivity of 81.8% and a specificity of 54.5%.

Conclusion

Middle-aged and elderly men with diabetes are more susceptible to NF， which commonly affects the lower limbs， with Klebsiella pneumoniae being the most common strain.The LRINEC score is an independent risk factor for poor prognosis in NF patients and has certain predictive value for poor prognosis.LRINEC score greater than or equal to 7.5 indicates poor prognosis in NF patients.