胫腓骨开放性骨折后感染患者降钙素原与C反应蛋白水平变化及其诊断意义  

The detection and diagnosis value of PCT and CRP in patients with open fracture of tibia and fibula

作　　者：邓亚开 陈伟南 DENG Ya-kai;CHEN Wei-nan(Department of Orhopaedics,904th Hospital of the Joint Service Support Force of the Peoples Liberaion Army,Wuxi,Jiangsu 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第904医院骨科,江苏无锡214000

出　　处：《中华全科医学》2020年第10期1663-1666,共4页Chinese Journal of General Practice

基　　金：江苏省自然科学基金面上项目(BK20161572)。

摘　　要：目的探究胫腓骨开放性骨折后感染患者的降钙素原(procaleitonin,PCT)、C反应蛋白(C-reactive protein,CRP)水平变化及其诊断意义。方法将2016年11月-2018年4月在中国人民解放军联勤保障部队第904医院骨科进行手术治疗的93例胫腓骨开放性骨折患者作为研究对象,按照是否发生感染将其分为感染组(36例)和非感染组(57例)。一期缝合后1、3、5、7和10d分别对2组患者的PCT,CRP水平变化进行测定,并于一期缝合后第10天对发生骨折感染的患者进行病原菌培养以明确其病原菌种类,就PCT、CRP在诊断胫腓骨开放性骨折后感染上的临床价值进行分析。结果:36例骨折后感染患者中共分离出病原菌54株,其中革兰阳性菌33株,占61.11%,革兰阴性菌18株,占33.33%,真菌3株,占5.56%。2组患者在一期缝合后1 d的PCT和CRP水平比较差异无统计学意义(均P>0.05);感染组患者在一期缝合后3、5.7和10d的PCT CRP水平均明显高于非感染组,2组患者的PCT,CRP水平在一期縫合后3 d达到峰值,之后逐渐下降,组间、组内比较差异有统计学意义(均P<0.05)。ROC分析发现,PCT、CRP以及PCT+CRP的AUC分别为0.863.0.813、0.912。PCT+CRP的敏感度、特异度、准确率分别为94.44%6.92.98%.93.55%,均高于PCT、CRP(分别为86.11%.84.21%、84.95%和72.22%、70.18%、70.97%)。结论PCTCRP水平与胫腓骨开放性骨折后感染密切相关,二者联合诊断能够显著提升骨折后早期感染的诊断准确性,可为其早期预防治疗提供重要参考。Objective To research the changes and diagnostic value of procalcitonin(PCT)and C reactive protein(CRP)levels in infectious patients with open fracture of tibia and fibula.Methods Total 93 patients with open fracture of tibia and fibula in our hospital from November 2016 to April 2018 were divided into the infection group(36 cases)and the non-infection group(57 cases).The levels of PCT and CRP were measured 1 day,3 days,5 days,7 days and 10 days after operation,and the clinical value of PCT and CRP in the diagnosis of infection after open fracture of tibia and fbula were analyzed.Results A total of 54 pathogens were isolated from 36 patients with fracture infection.Among them,33 strains were gram-positive bacteria(61.11%),18 strains were gram-negative bacteria(33.33%),and 2 strains were fungi(5.56%).There were no significant differences in the levels of PCT and CRP between the two groups 1 day after operation(P>0.05).The levels of PCT and CRP in the infection group were significantly higher than those in the non-infection group 3 days,5 days,7 days and 10 days after operation.The PCT and CRP levels of the two groups reached the peak 3 days after operation,and then gradually decreased(P<0.05).ROC analysis showed that the AUC of PCT,CRP,and PCT+CRP were 0.863,0.813 and 0.912,respectively.The sensitivity,specifcity and accuracy of PCT+CRP were 94.44%,92.98%and 93.55%respectively,which were higher than PCT and CRP(86.11%,84.21%,84.95%and 72.22%,70.18%,70.97%,respectively).Conclusion The levels of PCT and CRP are closely related to infection after open fracture of tibia and fibula.They can be used as an important index for clinical diag-nosis of infection after open fracture of tibia and fibula,and can provide reference for early diagnosis and prevention of in-fection.

关 键 词：胫腓骨开放骨折 骨折后感染 降钙素原 C反应蛋白 

分 类 号：R683.42[医药卫生—骨科学] R681.2[医药卫生—外科学]