降钙素原与超敏C反应蛋白联合动态检测对骨折术后感染的早期诊断价值

Early diagnostic value of combined dynamic monitoring of calcitonin and high sensitivity C-reactive protein in postoperative infection of fractures

目的探讨降钙素原(PCT)和超敏C反应蛋白(hs-CRP)联合动态监测对骨折术后并发感染的早期诊断价值。方法选择我院2014年1月~2016年12月行切开复位内固定术后并发感染的42例患者作为感染组,选取同期未感染的60例骨折手术患者作为对照组。所有患者均于术后1、4、7 d采用免疫比浊法检测血清PCT、hsCRP水平,比较两组患者血清PCT、hs-CRP的变化趋势。采用ROC曲线分析单独PCT、单独hs-CRP及两者联合检测对骨折术后并发感染的诊断价值。结果两组患者术后第1天血清PCT和hs-CRP水平均高于正常值,两组间差异无统计学意义(P>0.05)。术后第4天和术后第7天,感染组患者血清PCT、hs-CRP呈持续高水平状态,而对照组患者血清PCT、hs-CRP逐渐下降至正常值;两组比较差异均有统计学意义(P<0.01)。PCT和hs-CRP联合检测的灵敏度为95.2%,特异度为98.3%,均明显高于两项指标单独检测的灵敏度和特异度,差异有统计学意义(P<0.01)。结论血清PCT和hs-CRP联合检测提高了诊断的敏感度和特异度,对骨折术后并发感染的早期诊断具有重要意义。

Objective To investigate the early diagnostic value of the combined dynamic monitoring of calcitonin （PCT） and high sensitivity C-reactive protein（hs-CRP） in postoperative infection of fractures. Methods 42 patients who underwent open reduction and internal fixation and had postoperative infection were enrolled as the infection group. 60 pa- tients with uninfected fracture surgery in the same period were selected as the control group. The serum PCT and hs- CRP levels of all the patients were measured by immunoturbidimetry at 1, 4 and 7 days after operation. The changes of serum PCT and hs-CRP was compared between the two groups. The diagnostic values of individual PCT, individual hs- CRP and combined detection of PCT and hs-CRP in postoperative infection of fractures were analyzed by ROC curve. Results The levels of serum PCT and hs-CRP of the two groups were higher than normal values on the first day after operation. There was no significant difference between the two groups（P〉0.05）. On the 4th day and the 7th day after operation, PCT and hs-CRP in the infection group sustained high levels, while the serum PCT and hs-CRP in the control group decreased to the normal levels. The difference between the two groups was statistically significant（P〈O.O1）. The sensitivity and specificity of PCT and hs-CRP combined detection was 95.2% and 98.3%, respectively, which was sig- nificantly higher than that of the individual detection of the two indicators（P〈0.01）. Conclusion The combined detection of serum PCT and hs-CRP improves the sensitivity and specificity of diagnosis, which is of great significance in the early diagnosis of complicated postoperative infection of fractures.