Taviloglu Korhan, Cabioglu Neslihan, Cagatay Atahan, Yanar Hakan, Ertekin Cemalettin, Baspinar Irfan, Ozsut Halit, Guloglu Recep
Trauma and Surgical Emergency Service, Department of General Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
Am Surg. 2005 Apr;71(4):315-20.
The prognosis of necrotizing fasciitis (NF) depends on early diagnosis and management. Idiopathic NF may be more challenging, because it occurs in the absence of a known causative factor. Therefore, our purpose in this study was to identify the distinct features of idiopathic NF that may be important in early recognition of this disease and determine the factors associated with mortality. A retrospective chart review was performed in patients with a diagnosis of NF between 1988 and 2003. Patients were classified as idiopathic and secondary NF, and data were analyzed in terms of etiological and predisposing factors, causative microbiological organisms, and clinical outcome. The study included 98 patients, 63 men and 35 women, with a diagnosis of NF. The median age was 55.5 years (range, 13 - 80). Idiopathic NF occurred in 60 of 98 patients (61%). The principal anatomic sites of infection for NF were perineal localisation in 55 patients (66%) and extremities in 31 patients (32%). Characteristics that distinguish patients with idiopathic NF from secondary NF were as follows: age older than 55 years (P = 0.0001), presence of comorbid illnesses like DM (P = 0.007) or chronic renal failure (P = 0.041), and perineal localization (P = 0.008). By logistic regression analysis, independent risk factors for idiopathic NF remained age > 55 years and perineal localization as statistically significant factors, when all the significant variables found in univariate analysis were included in the model. The majority of patients (82%) had polymicrobial infections. The mortality rate was 35 per cent. All patients were treated with radical surgical debridement and a combination of antibiotics. Female gender, presence of malignant disease, and diabetes mellitus (DM) were found to be associated with increased mortality as independent factors in logistic regression analysis, when all of these three factors were included in the model. Understanding the distinct clinical characteristics and the factors associated with mortality in patients with NF may lead to rapid diagnosis and improve the survival rates. Therefore, idiopathic NF is a crucial entity that requires serious suspicion for its diagnosis.
坏死性筋膜炎（NF）的预后取决于早期诊断和治疗。特发性NF可能更具挑战性，因为它在没有已知致病因素的情况下发生。因此，我们在本研究中的目的是确定特发性NF的独特特征，这些特征可能对该疾病的早期识别很重要，并确定与死亡率相关的因素。对1988年至2003年间诊断为NF的患者进行了回顾性病历审查。患者被分为特发性和继发性NF，并根据病因和易感因素、致病微生物以及临床结果对数据进行分析。该研究包括98例诊断为NF的患者，其中63例男性和35例女性。中位年龄为55.5岁（范围13 - 80岁）。98例患者中有60例（61%）发生特发性NF。NF感染的主要解剖部位为55例（66%）会阴部位和31例（32%）四肢。将特发性NF患者与继发性NF患者区分开来的特征如下：年龄大于55岁（P = 0.0001）、存在合并症如糖尿病（P = 0.007）或慢性肾衰竭（P = 0.041）以及会阴部位感染（P = 0.008）。通过逻辑回归分析，当单因素分析中发现的所有显著变量都纳入模型时，特发性NF的独立危险因素仍然是年龄> 55岁和会阴部位感染，这两个因素具有统计学意义。大多数患者（82%）有混合微生物感染。死亡率为35%。所有患者均接受了根治性手术清创和抗生素联合治疗。在逻辑回归分析中，当将这三个因素都纳入模型时，发现女性性别、恶性疾病的存在以及糖尿病（DM）作为独立因素与死亡率增加相关。了解NF患者的独特临床特征和与死亡率相关的因素可能有助于快速诊断并提高生存率。因此，特发性NF是一个关键的疾病实体，其诊断需要高度怀疑。
