CRP、PCT、ESR及WBC监测在腰椎后路内固定术后早期感染的临床价值分析

Clinical value of monitoring of CRP,PCT,ESR,and WBC in diagnosis of early infection after posterior lumbar internal fixation

目的探讨C反应蛋白(CRP)、降钙素原(PCT)、红细胞沉降率(ESR)、白细胞计数(WBC)检测在腰椎后路内固定术后早期感染诊断中的价值,以期为临床提供诊治依据。方法收集医院2012年1月-2014年1月拟行腰椎后路内固定术治疗患者154例,分为感染组40例与非感染组114例,观察两组患者感染部位,术前术后不同时间WBC、ESR、CRP、PCT水平变化,以及迟发性感染率与治疗效果。结果感染组术后3、5、7d各项指标均高于同组术前、术后1d及非感染组同期(P<0.05),两组术后1d观察指标CRP高于同组术前(P<0.05);感染组不同感染部位术后1d各项观察指标对比无明显差异,切口浅部感染患者术后3、5、7d各项指标(WBC除外)高于术后1d(P<0.05),低于切口深部及其他部位感染术后同期(P<0.05);所有感染患者酌情治疗后均痊愈出院;随访1年,两组迟发性感染发生率对比无明显差异,感染组总有效率低于非感染组(P<0.05)。结论腰椎后路内固定术后早期监测血清感染指标水平可作为预测早期感染依据,特别是ESR、CRP、PCT指标联合检测,对预测早期感染意义重大。

OBJECTIVE To explore the value of detection of C‐reactive protein （CRP） ,procalcitonin （PCT ） ,eryth‐rocyte sedimentation rate （ESR） ,and white blood cell （WBC） counts in diagnosis of early infection after posterior lumbar internal fixation so as to provide guidance for clinical diagnosis and treatment .METHODS A total of 154 patients who underwent the posterior lumbar internal fixation in hospitals from Jan 2012 to Jan 2014 were enrolled in the study and divided into the infection group with 40 cases and the non‐infection group with 114 cases .The in‐fection sites of the two groups of patients were observed ,the changes of the levels of WBC ,ESR ,CRP and PCT were analyzed before and after the surgery ,and the delayed infection rate and curative effect were observed . RESULTS The levels of the indexes of the infection group were higher after the surgery for 3 ,5 ,and 7 days than before the surgery and after the surgery for 1 day ;the levels of the indexes of the infection group were higher than those of the non‐infection group （P〈0 .05） .The CRP level of the two groups of patients was higher after the sur‐gery for 1 day than before the surgery （P〈0 .05） .The observation indexes did not vary significantly among the patients with different sites of infection in the infection group after the surgery for 1 day ;the levels of the indexes （except WBC） of the patients with shallow incision infection were higher after the surgery for 3 ,5 ,and 7 days than after the surgery for 1 day （P〈0 .05） and were lower than those of the patients with deep incision infection and the patients with other sites of infection during the same periods （P〈0 .05） .All of the patients with infection were cured and discharged after appropriate treatment .A one‐year follow‐up showed that there was no significant difference in the incidence of delayed infections between the two groups ,and the total effective rate of the infection group was lower than that of the non‐infection group （P〈0 .05） .CONCLUSION The levels of serological infection indexes can provide bases for prediction of early infection after the posterior lumbar internal fixation ,in particular‐ly ,the joint detection of ESR ,CRP ,and PCT has great significance in prediction of the early infection .