炎症标志物在感染性和痛风性关节炎中鉴别诊断的应用价值

Evaluation of Several Inflammatory Markers to Infectious and Gouty Arthritis

目的：研究不同炎症标志物在不同类型关节炎中的鉴别诊断价值。方法2013年1月-2014年1月在沈阳军区总医院骨科病房住院患者中，33例感染性关节炎和29例痛风性关节炎病人中，检测血浆中白细胞数量、C 反应蛋白以及尿酸水平和关节滑液中乳酸、葡萄糖、尿酸、乳酸脱氢酶、白细胞等相关炎症标志物，再通过受试者工作曲线分析不同标志物的诊断价值。结果在两组患者中，只有血浆白细胞和 C 反应蛋白水平不存在统计学差异，关节滑液中乳酸浓度检测的诊断价值最高，曲线下面积（AUC）为0.898，特异度为72.4％，敏感度为96.9％；其次为血清尿酸和滑液尿酸两项指标， AUC 分别为0.818和0.808。结论在感染性关节炎中乳酸标志物有良好的诊断价值，滑液中乳酸水平高于1.7 mmol／L基本可以诊断为感染性关节炎。

Objective The aim of this study was to investigate which inflammatory markers allow an accurate differentiation of septic and gouty arthritis.Methods In 2013 January to 2014 January 33 patients with septic arthritis and 29 patients with gouty arthritis.Detected white blood cells,C-reactive protein and uric acid of inflammatory markers in plasma and tested lac-tate,glucose,uric acid,lactate dehydrogenase and white blood cell count inflammatory markers in the synovial fluid.MedCalc 13.0 software were used for statistical analysis.Results There were no significantly different between serum C-reaction protein and WBC counts with two groups.Synovial lactate showed the greatest diagnostic potential （AUC=0.898,sensitivi-ty=96.9%,specificity=72.4%）followed by serum uric acid （AUC=0.818）and synovial uric acid （AUC=0.808）.Con-clusion Lactate in the synovial fluid has excellent diagnostic potential to differ septic arthritis from gouty arthritis.Synovial lactate levers above 1.7 mmol/L almost proofed septic arthritis.