4种血清感染指标在关节置换术患者早期发热中的监测评价

Monitoring and evaluation of 4 kinds of serum infection indexes in early fever of patients undergoing joint replacement

目的研究血清降钙素原(PCT)、C反应蛋白(CRP)、红细胞沉降率(ESR)水平及白细胞计数(WBC)在关节置换术后早期发热患者的监测价值,及时发现、预防和治疗感染患者。方法选择2013年1月-2014年12月进行关节置换术并早期发热的患者160例;按照患者细菌学培养的结果将其分为感染组72例和未感染组88例;比较两组患者及组内患者之间血清PCT、CRP、ESR水平以及WBC计数。结果手术前两组患者PCT、CRP、ESR、WBC相近,手术后,感染组PCT、CRP、ESR较高,差异有统计学意义(P<0.05),WBC计数相近;未感染组患者PCT、CRP、ESR、WBC总体呈先上升后下降的趋势,术后7d患者WBC和PCT基本恢复到术前水平,ESR和CRP水平仍然较高;术后发热并发感染的患者中,PCT水平在不同感染类型的患者差异有统计学意义(P<0.05),因此可用于不同感染类型的鉴别,而CRP、ESR、WBC三种指标在不同类型感染患者中比较,差异无统计学意义;PCT、CRP、ESR三者对应的ROC曲线(P<0.05),可用于诊断术后发热是否由感染引起。结论合理选择感染指标在关节置换术患者的早期感染诊断中具有较好的参考价值,PCT受手术影响较小,可用于鉴定感染类型,CRP和ESR可作为辅助检测指标。

OBJECTIVE To study the monitoring value of serum PCT,CRP,ESR levels and WBC count in patients in early fever after joint replacement surgery,so as to be able to provide detection,prevention and treatment timely for patients.METHODS A total of 160 cases of patients with fever after joint replacement surgery from Jan.2013 to Dec.2014 were selected.According to the results of cultivation of bacteriology,patients were divided into infection group（n=72）and the uninfected group（n=88）.The level of serum PCT,CRP,ESR and WBC count were compared between the two groups of patients.RESULTS Before the operation,the PCT,CRP,ESR,WBC indexes in two groups were similar,but after the operation,the indexes of PCT,CRP and ESR in infection group were obviously higher than in uninfected group and the WBC count was similar.The trend of indexes of PCT,CRP,ESR and WBC in uninfected group first rose up then fell down.After 7days of operation,the WBC and PCT recovered to preoperative levels,but ESR and CRP levels were still high.In patients with postoperative fever,the change of PCT level in patients with different types of infection had significant difference（P〈0.05）,which could be used for the identification of different types infections,but CRP,ESR and WBC had no significant difference in different types of infections.The curves of PCT,CRP and ESR on ROC were all statistically significant（P〈0.05）,which could be used in the diagnosis of postoperative fever caused by infection.CONCLUSION Reasonable choice of infection indexes in the early diagnosis of infection of patients with joint replacement has good reference value.PCT has less influence by the surgery,which can be used to identify the types of infection,and ESR and CRP can be used as auxiliary indexes.