术前ESR和CRP水平与类风湿关节炎关节置换术后感染的相关性研究  

Correlation analysis between preoperative ESR/CRP and postoperative infection in patients with rheumatoid arthritis undergoing primary joint arthroplasty

作　　者：王加兴[1] 王津 王俏杰[1] 沈灏[1] 张先龙[1] WANG Jiaxing;WANG Jin;WANG Qiaojie;SHEN Hao;ZHANG Xianlong(Department of Orthopedics,the Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《国际骨科学杂志》2020年第3期175-179,共5页International Journal of Orthopaedics

基　　金：国家自然科学基金(81802181);上海市青年科技英才扬帆计划(18YF1418800)。

摘　　要：目的探讨类风湿关节炎(RA)患者术前红细胞沉降率(ESR)和C反应蛋白(CRP)水平与人工关节置换术后感染发生的相关性。方法回顾性分析上海交通大学附属第六人民医院收治的203例行初次人工关节置换术的RA患者临床资料,记录术前ESR和CRP、手术部位类型、术后感染及其他感染危险因素等指标,比较不同组别患者术后感染发生率的差异。结果203例患者中,术前ESR正常者78例,升高者125例,术前CRP正常者33例,升高者170例。所有患者术前ESR和CRP的平均值分别为55mm/h(29.3~85.0mm/h)和15.3mg/L(5.1~27.2mg/L)。5例患者发生术后感染,其中2例行双侧关节置换的患者ESR和CRP均升高,其他3例行单侧置换的患者ESR和CRP至少1项正常。术后感染风险与术前CRP和ESR水平增高无明显相关性。同时行双侧关节置换的患者术后感染发生率更高。其他风险因素如年龄、性别、是否使用抗生素骨水泥及是否使用免疫抑制剂等对术后感染没有显著影响。结论RA患者术前ESR和CRP水平与人工关节置换术后感染发生无直接相关性,但若合并其他危险因素或行双侧关节置换,则会大大增加感染的风险。Objective To investigate the correlation between the preoperative serum erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)levels in patients with rheumatoid arthritis(RA)and the incidence of postoperative infection after total joint arthroplasty.Methods The clinical data of 203 RA patients undergoing primary total joint replacement in our hospital were retrospectively analyzed.The preoperative ESR and CRP levels,the type of arthroplasty,postoperative infection,and other risk factors for infection were recorded.The incidences of postoperative infection in different groups of patients were compared.Results Among the 203 patients,78 patients had normal ESR,125 patients had elevated ESR;33 patients had normal CRP,and 170 patients had elevated CRP.The average preoperative ESR and CRP levels were 55(ranging from 29.3 to 85.0)mm/h and 15.3(ranging from 5.1 to 27.2)mg/L,respectively.Five patients developed postoperative infections.ESR and CRP were both elevated in two patients who underwent bilateral joint replacements,while the ESR and/or CRP was normal in the rest three patients who underwent unilateral arthroplasty.There was no significant correlation between the postoperative infection and preoperative CRP and ESR levels.Patients undergoing bilateral arthroplasties simultaneously were more likely to be infected after surgery.Other risk factors,such as age,gender,the use of antibiotic cement,and the use of immunosuppressants,did not significantly affect the postoperative infection.Conclusion There is no direct correlation between the preoperative ESR and CRP of RA patients and the occurrence of infection after joint replacement,but if other risk factors coexist or bilateral total joint replacements are performed simultaneously,it will probably increase the risk of postoperative infection.

关 键 词：红细胞沉降率 C反应蛋白 类风湿关节炎 初次人工关节置换 感染 

分 类 号：R687.4[医药卫生—骨科学]