降钙素原在诊断脊柱内置物术后早期感染性发热中的应用价值  

Diagnostic value of PCT in detecting early postoperative infectious fever in spine surgery with implant

作　　者：李修璨 韩振川 张雅宾[1] 熊森[1] 王旭翾[1] 姜威[1] 毛克亚[1] LI Xiucan HAN Zhenchuan ZHANG Yabin XIONG Sen WANG Xuxuan JIANG Wei MAO Keya(Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《解放军医学院学报》2016年第12期1233-1236,共4页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金面上项目(51372276)~~

摘　　要：目的评价降钙素原（procalcitonin,PCT）在脊柱内置物术后早期发热患者感染诊断中的价值。方法回顾性分析本院2013年1月-2015年1月行脊柱（颈椎、胸椎、腰椎）内置物术后10 d内出现发热的患者101例,根据金标准（细菌培养）分为感染组（A组,n=40）和非感染组（B组,n=61）,记录术后发热时降钙素原、C反应蛋白（C-reactive protein,CRP）、红细胞沉降率（erythrocyte sedimen-tation rate,ESR）的变化并比较A、B两组间的差异。通过受试者工作特征（receiver operating characteristics,ROC）曲线比较降钙素原对早期感染的诊断价值,并计算出该指标的最佳界限值。结果两组中3项指标均较术前有显著升高（P〈0.05）,A组PCT、CRP高于B组,但ESR差异无统计学意义（P〉0.05）。ROC曲线中PCT的曲线下面积（0.861,95%CI：0.77~0.94,P=0.000）显著大于CRP（0.689,95%CI：0.58~0.79,P=0.001）,PCT诊断感染的最佳界限值是0.47 ng/ml。结论血清降钙素原浓度对于早期脊柱内置物术后感染的诊断有较高价值。Objective To evaluate the value of procalcitonin（PCT） in detecting infection among patients with fever after spine surgery with implants. Methods Clinical data about a total of 101 patients received spine surgery and developed postoperative fever（within 10 d） in Chinese PLA General Hospital from January 2013 to January 2015 were analyzed retrospectively. The patients were divided into infection group（group A, n=40） and non-infection group（group B, n=61） according to the Golden Standard（blood culture results）. PCT, CRP and ESR were tested before surgery, during fever and the differences between two groups were compared. The diagnostic value of PCT on early infectious fever was analyzed and its optimal threshold value was evaluated by receiver operating characteristics（ROC） curve. ResultsAll indicators increased significantly after surgery in both two groups（P〈0.05）. PCT and CRP were higher in group A than group B, while the difference in ESR was not significant（P〉 0.05）. The area under ROC curve of PCT（0.861, 95% CI： 0.77–0.94, P=0.000） was bigger than CRP（0.689, 95% CI： 0.58–0.79, P=0.001）. The optimal cutoff point of PCT to detect infection was 0.47 ng/ml. Conclusion Serum PCT is a reliable biological marker to detect early postoperative infectious complications in spinal surgery with implant.

关 键 词：降钙素原 脊柱外科 术后感染 

分 类 号：R687.4[医药卫生—骨科学]