应激性高血糖比率联合C反应蛋白与降钙素原在胫腓骨开放性骨折患者术后感染中的评估价值  

Evaluation value of stress hyperglycemia ratio combined with C-reactive protein and procalcitonin in the evaluation of postoperative infection in patients with open tibiofibular fracture

作　　者：孙博[1] 王静悦 李冀[1] 李彬[1] 蒋雨宸 Sun Bo;Wang Jingyue;Li Ji;Li Bin;Jiang Yuchen(Department of Traumatology 3,The Second Hospital of Tangshan,Tangshan 063000,China;Department of Neurology Second Ward,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)

机构地区：[1]河北省唐山市第二医院创伤三科,唐山063000 [2]华北理工大学附属医院神经内科二病区,唐山063000 [3]华北理工大学附属医院骨科病区,唐山063000

出　　处：《中国综合临床》2024年第2期96-103,共8页Clinical Medicine of China

基　　金：河北省医学科学研究课题计划(20201238);河北省省属高等学校基本科研业务费研究项目(JQN2020001);唐山市人才资助项目(A20200326)。

摘　　要：目的探究胫腓骨开放性骨折患者应激性高血糖比率(stress hyperglycemia ratio,SHR)、C反应蛋白(C reactive protein,CRP)、血清降钙素原(procalcitonin,PCT)对其术后感染的评估价值。方法本研究为前瞻性分析。收集2018年1月至2023年1月于唐山市第二医院、华北理工大学附属医院骨外科住院治疗的胫腓骨开放性骨折患者为研究对象,完成结局评定共839例,依据所选入组研究对象是否发生术后感染分为感染组(103例)和非感染组(736例),单因素分析两组患者临床资料,再经多因素Logistic回归分析胫腓骨开放性骨折术后感染的危险因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,分析SHR、CRP、PCT及三者联合模型对不良结局的预测效能。结果单因素分析示:感染组SHR 1.82±0.31、CRP(92.28±36.07)mg/L、PCT(6.35±1.79)μg/L,非感染组三者分别为1.05±0.12、(56.35±10.21)mg/L、(2.17±0.41)μg/L,两组比较差异均有统计学意义(t值分别为46.90、21.60、54.17,均P<0.001);感染组中白蛋白<30 g/L所占比率63.11%(65/103),高于非感染组37.64%(277/736)(χ^(2)=24.28,P<0.001),且两组在受伤至手术时间比率[感染组≥6 h为71.84%(74/103),<6 h为28.16%(29/103);非感染组≥6 h为43.07%(317/736),<6 h为56.93%(419/736);χ^(2)=35.37,P<0.001]、Gustilo-Anderson分型比率[感染组Ⅰ、Ⅱ型为44.46%(46/103),ⅢA型为33.98%(35/103),ⅢB型为12.62%(13/103),ⅢC型为8.47%(9/103);非感染组Ⅰ、Ⅱ型为59.10%(435/736),ⅢA型为32.47%(239/736),ⅢB型为5.98%(44/736),ⅢC型为2.45%(18/736);χ^(2)=20.34,P<0.001]、术后引流比率[感染组为40.60%(48/103),58.02%(427/736);χ^(2)=4.79,P=0.029]方面,差异均有统计学意义;多因素Logistic回归分析示:SHR(OR=1.871,95%CI 1.621~2.160,P<0.001)、CRP(OR=1.060,95%CI 1.015~1.107,P=0.009)、PCT(OR=1.497,95%CI 1.420~1.577,P<0.001)是胫腓骨开放性骨折发生术后感染的独立危险因素,其中SHR的OR值最大,为发生研究结局的最强影响�Objective To explore the the evaluation value of stress hyperglycemia ratio(SHR),C-reactive protein(CRP),and serum procalcitonin(PCT)for postoperative infection in patients with open tibiofibular fractures.Methods This study was a prospective analysis.Patients with open tibiofibular fractures hospitalized in the Department of Orthopaedic Surgery of The Second Hospital of Tangshan and North China University of Science and Technology Affiliated Hospital from January 2018 to January 2023 were collected as the research objects,and a total of 839 cases were assessed for outcome,which were divided into infection group(103 cases)and non-infection group(736 cases)according to whether the selected subjects had postoperative infection.The clinical data of the two groups were analyzed by univariate analysis,and the risk factors of postoperative infection of open fracture of tibia and fibula were analyzed by multivariate Logistic regression,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficacy of SHR,CRP,PCT,and their combined models on adverse outcomes.Results Univariate analysis showed that the infection group had SHR(1.82±0.31),CRP(92.28±36.07)mg/L,PCT(6.35±1.79)μg/L,the non infection group had(1.05±0.12),(56.35±10.21)mg/L and(2.17±0.41)μg/L,respectively,and there were significant differences between the two groups(t values were 46.90,21.60,and 54.17,respectively;all P<0.001).The proportion of albumin(<30 g/L)in the infection group was higher than that in the non-infection group(63.11%(65/103),37.64%(277/736))(χ^(2)=24.28,P<0.001),and the two groups had significant differences in the rate of time from injury to operation(the infection group≥6 h was 71.84%(74/103),<6 h was 28.16%(29/103);the non-infection group≥6 h was 43.07%(317/736),<6 h was 56.93%(419/736);χ^(2)=35.37,P<0.001),the rate of Gustilo-Anderson classification(the infection groupⅠ、Ⅱwas 44.46%(46/103),ⅢA was 33.98%(35/103),ⅢB was 12.62%(13/103),ⅢC was 8.47%(9/103);the non-infection groupⅠ、

关 键 词：应激性高血糖比率 C反应蛋白 降钙素原 胫腓骨开放性骨折 术后感染 

分 类 号：R687.3[医药卫生—骨科学]