关节置换术后降钙素原、白介素-6、C-反应蛋白联合检测对诊断术后早期感染的临床意义

Clinical significance of combined testing of PCT, IL-6 and CRP on the diagnosis of postoperative early injections after joint replacement

目的 探讨血清降钙素原（PCT）、白介素-6（IL-6）、C-反应蛋白（CRP）对关节置换术后出现早期感染的诊断价值。方法 选取2014年1月~2016年1月在我院骨科进行关节置换术治疗的115例患者,5例术后感染患者作为感染组,110例未发生感染患者作为未感染组。采用双抗体夹心免疫化学发光法、ELISA法及全自动免疫透视比浊法检测所有患者血清PCT、IL-6及CRP水平。结果 术后第1天,感染组患者与非感染组患者的血清PCT、IL-6和CRP水平均较术前明显升高（P〈0.05）,感染组患者术后CRP水平明显高于未感染组（P〈0.05）;术后第3、7天感染组血清PCT、IL-6和CRP水平均明显高于未感染组（P〈0.05）;两组患者术后1 d、3 d内PCT、IL-6和CRP水平均有一个明显升高的过程（P〈0.05）,术后7 d,感染组患者的PCT、IL-6和CRP水平持续升高（P〈0.05）,未感染组患者在7 d逐渐恢复术前水平（P〉0.05）;PCT＋IL-6＋CRP联合检测的灵敏性为96.21%,特异性为86.32%,均明显高于各项指标单独检查的灵敏性及特异性。结论 血清PCT、IL-6和CRP三者联合检测提高了诊断的灵敏性和特异性,动态监测血清PCT、IL-6和CRP水平对诊断关节置换术后早期感染极具临床价值。

Objective To explore the diagnostic value of serum PCT, IL-6, and CRP on early infections after joint re- placement therapy. Methods 115 patients who were given the treatment of joint replacement therapy in the Department of Orthopedics in our hospital from January 2014 to January 2016 were selected. 5 patients who were infected after the therapy were assigned to the infection group, and other 110 patients who were not infected were assigned to the non- infection group. Serum PCT, IL-6 and CRP levels were tested via double antibody sandwich immunochemiluminometric assay, ELISA method and automated immune perspective turbidimetry in all patients. Results On the first day after the surgery, serum PCT, IL-6 and CRP levels in the infection group and non-infection group were significantly higher than those before the surgery（P〈0.05）, and CRP level in the infection group was significantly higher than that in the non-in- fection group（P〈0.05）; serum PCT, IL-6 and CRP levels in the infection group 3 and 7 days after the surgery were sig- nificantly higher than those in the non-infection group（P〈0.05）; PCT, IL-6 and CRP levels in both groups 1 day and 3 days after the surgery were significantly increasing（P〈0.05）, PCT, IL-6 and CRP levels were continuously increasing in the infection group （P〈0.05）, and the levels were gradually resumed to the levels before the surgery on 7d in the non- infection group（P〉0.05）; the sensitivity of combined testing of PCT＋IL-6＋CRP was 96.21%, and the specificity was 86.32%, both significantly higher than the sensitivity and specificity of each index tested alone. Conclusion Combined testing of serum PCT, IL-6 and CRP is able to improve the sensitivity and specificity of the diagnosis. Dynamic moni- toring of serum PCT, IL-6 and CRP levels are of significant clinical value in the diagnosis of early infection after joint replacement therapy.