以皮肤软组织感染为主要征象的儿童急性骨髓炎发病初期的临床特征  

Analysis of clinical features of children with tendency of skin soft tissue infection to osteomyelitis

作　　者：贾海亭 王玉亭 孙琳[2] 刘涛[1] 于嘉智[1] 王世富[3] Jia Haiting;Wang Yuting;Sun Lin;Liu Tao;Yu Jiazhi;Wang Shifu(Department of Orthopaedic Trauma Surgery,Children's Hospital Affiliated to Shandong University(Jinan Children's Hospital),Jinan 250022,China;Department of Orthopaedics,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China;Department of Clinical Microbiology,Children's Hospital Affiliated to Shandong University(Jinan Children's Hospital),Jinan 250022,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)骨科创伤外科,济南250022 [2]首都医科大学附属北京儿童医院骨科,北京100045 [3]山东大学附属儿童医院(济南市儿童医院)临床微生物室,济南250022

出　　处：《中华骨科杂志》2023年第21期1427-1432,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨以皮肤软组织感染为主要征象的儿童急性骨髓炎发病初期的临床特征。方法回顾性分析2017年7月至2023年2月以皮肤软组织感染为主要征象就诊的154例患儿资料,根据MRI将无骨髓炎征象仅表现为单纯皮肤软组织感染的48例患儿纳入非骨髓炎组,男28例、女20例,年龄38.50(12.00,93.00)个月;将存在骨髓炎征象且同时表现为皮肤软组织感染的106例患儿纳入骨髓炎组,男65例、女41例,年龄49.50(17.50,87.00)个月。对两组患儿病程、发病时最高体温、入院24 h内检查的炎症指标(包括白细胞计数、中性粒细胞计数、C反应蛋白、红细胞沉降率)进行对比,并根据受试者特征(receiver operating characteristic,ROC)曲线判断各指标诊断骨髓炎的效能。结果非骨髓炎组和骨髓炎组白细胞计数分别为13.72(10.19,19.19)×10^(9)/L和14.74(10.63,18.67)×10^(9)/L,中性粒细胞计数分别为7.79(5.62,11.91)×10^(9)/L和9.58(5.77,13.67)×10^(9)/L,差异均无统计学意义(Z=-0.68,P=0.495;Z=-1.24,P=0.216)。非骨髓炎组和骨髓炎组病程分别为5.00(3.00,7.00)d和5.50(4.00,9.00)d(Z=-2.03,P=0.042),发病时最高体温分别为38.50(36.65,39.00)℃和39.00(38.50,40.00)℃(Z=-3.72,P<0.001),C反应蛋白分别为23.26(8.16,47.67)mg/L和69.27(26.28,111.03)mg/L(Z=-4.52,P<0.001),红细胞沉降率分别为35.00(24.25,53.00)mm/1 h和61.00(43.00,78.00)mm/1 h(Z=-5.06,P<0.001),差异均有统计学意义。非骨髓炎组和骨髓炎组C反应蛋白升高人数比例分别为70.8%(34/48)和92.5%(98/106)、红细胞沉降率升高人数比例分别为81.3%(39/48)和100%(106/106)、发热人数比例分别为66.7%(32/48)和100%(106/106),差异均有统计学意义(χ^(2)=12.61,P<0.001;χ^(2)=21.11,P<0.001;χ^(2)=39.43,P<0.001)。对诊断以皮肤软组织感染为主要征象的骨髓炎的效能,病程的灵敏度、特异度和曲线下面积分别为84.0%、33.3%和0.602,发病时最高体温分别为99.1%、35.4%和0.687,C反应蛋白分别为57.6%、85.Objective To investigate the clinical features of the initial phase of acute osteomyelitis in children with skin and soft tissue infection as the main sign.Methods The clinical data of 154 children with skin and soft tissue infections as the main sign from July 2017 to February 2023 were retrospectively analyzed.According to MRI,48 children with no signs of osteomyelitis and only simple skin and soft tissue infection were included in the non-osteomyelitis group,including 28 boys and 20 girls,aged 38.50(12.00,93.00)months;106 children with acute osteomyelitis with skin and soft tissue infection as the main sign were included in the osteomyelitis group,including 65 boys and 41 girls,aged 49.50(17.50,87.00)months.The disease course,maximum body temperature at onset,inflammatory indicators(including white blood cell count,neutrophil count,C-reactive protein,erythrocyte sedimentation rate)examined within 24 h after admission were compared between the two groups,and receiver operating characteristic(ROC)curve was used to evaluate the efficacy of each index in diagnosing osteomyelitis.Results The white blood cell counts in the non-osteomyelitis group and osteomyelitis group were 13.72(10.19,19.19)×10^(9)/L and 14.74(10.63,18.67)×10^(9)/L,and the neutrophil counts were 7.79(5.62,11.91)×10^(9)/L and 9.58(5.77,13.67)×10^(9)/L,the difference was not statistically significant(Z=-0.68,P=0.495;Z=-1.24,P=0.216).The course of disease in the non-osteomyelitis group and osteomyelitis group was 5.00(3.00,7.00)d and 5.50(4.00,9.00)d(Z=-2.03,P=0.042),and the maximum body temperature at the onset of the disease was 38.50(36.65,39.00)℃and 39.00(38.50,40.00)℃(Z=-3.72,P<0.001),C-reactive protein was 23.26(8.16,47.67)mg/L and 69.27(26.28,111.03)mg/L(Z=-4.52,P<0.001),erythrocyte sedimentation rate was 35.00(24.25,53.00)mm/1 h and 61.00(43.00,78.00)mm/1 h(Z=-5.06,P<0.001),the differences were statistically significant.The proportion of patients with increased C-reactive protein was 70.8%(34/48)and 92.5%(98/106)in non-osteomyelitis g

关 键 词：儿童 软组织感染 骨髓炎 

分 类 号：R726.8[医药卫生—儿科]