降钙素原诊断骨科大手术后手术部位感染的临床研究  

Clinical research of procalcitonin in the diagnosis of surgical site infection after major surgery in orthopedics department

作　　者：李之琛[1] 卢伟杰[1] 陈东峰[1] 刘琦[1] 钱东阳[1] 钟树栅 陈玉书[1] 王鹏坤[2] 

机构地区：[1]广州医科大学附属第一医院骨外科,广州510120 [2]广州医科大学附属第一医院检验科,广州510120

出　　处：《中国骨与关节外科》2016年第5期432-435,共4页Chinese Journal of Bone and Joint Surgery

基　　金：广州市医药卫生科技一般引导项目(编号:20141A010069)

摘　　要：背景:骨科大手术后手术部位感染(surgical site infection,SSI)的早期诊断存在困难。血清降钙素原(procalcitonin,PCT)已被证明是诊断感染的标志物之一,但其应用于骨科大手术后SSI的效果尚不清楚。目的目的:评价PCT诊断骨科大手术后SSI的作用。方法方法:前瞻性研究2011年1月至2016年6月骨科大手术后伤口渗液患者53例,根据伤口分泌物细菌培养及清创手术结果分为非感染组与SSI组,检测PCT、C反应蛋白(C-reactive protein,CRP)并进行组间比较,评价血清PCT诊断SSI的敏感性与特异性。结果结果:SSI组31例,革兰阳性球菌感染率为54.8%(17/31),血PCT值为(0.498±0.753)ng/ml,明显高于非感染组的(0.133±0.164)ng/ml(P<0.05)。以0.5 ng/ml作为SSI的诊断阈值,血清PCT诊断骨科大手术后SSI的敏感性为26.7%,特异性为95.5%。结论结论:PCT鉴别骨科大手术后伤口渗液病例中SSI的特异性高,但敏感性较差,不适合作为骨科大手术后SSI的诊断指标。Background： It is very difficult to diagnose surgical site infection （SSI） as soon as it happened after major sur- gery in orthopedics department. Serum procalcitonin （PCT） has been proved a good biomarker in detecting infection. How- ever, its effect is still unknown in the field of orthopedics. Objective： To evaluate the effect of PCT on the diagnosis of SSI after major surgery in orthopedics department. Methods： Fifty-three patients undergoing major surgery in orthopedics depart- ment between January 2011 and June 2016 were included in this prospective clinical study. Drainage, a clinical sign of SSI, was found in these patients after surgery. According to the results of bacterial cultures of specimens from the wound and the findings in the process of debridement, the patients were divided into non-infection group and SSI group. Serum PCT and C- reactive protein （CRP） were detected and compared between the two groups. Sensitivity and specificity of PCT in diagnosis of SSI were evaluated. Results： Eventually, 31 patients were diagnosed as SSI, and the infection rate of Gram-positive bacte- ria was 54.8% （17/31）. Serum PCT level was （0.498±0.753） ng/ml in SSI group, which was significantly higher than that in non-infection group （[0.133 ±0.164] ng/ml, P〈0.05）. When 0.5ng/ml PCT was applied as threshold in diagnosing SSI, the sensitivity and specificity of diagnosis were 26.7% and 95.5%, respectively. Conclusions： With a poor sensitivity, serum PCT is not proper for a marker in diagnosing SSI after major surgery in orthopedics department.

关 键 词：降钙素 感染 敏感性与特异性 革兰氏阳性菌 

分 类 号：R687[医药卫生—骨科学]