腰椎内固定术后血清C反应蛋白和红细胞沉降率水平对中期感染的预测作用

Value of serum C-reactive protein and erythrocyte sedimentation rate in predicting mid-term infection after lumbar spinal internal fixation

目的评价腰椎内固定术后血清CRP和ESR水平对中期感染的预测价值。方法选取行腰椎内固定术并于术后2~10周出现发热的患者,根据细菌培养结果分成感染组(A组)27例和非感染组(B组)25例,比较2组患者的血清CRP和ESR水平,根据CRP和ESR水平作受试者工作特征(ROC)曲线,分析血清CRP和ESR水平在腰椎内固定术后患者中期感染的预测价值。结果 27例确诊为感染的患者,其中手术切口浅表感染7例,手术切口深部感染8例,肺部感染8例,泌尿系感染4例。4种感染类型的发热后血清CRP、ESR比较,差异有统计学意义(P<0.05)。2组患者发热时的CRP、ESR值比较,A组显著高于B组(P<0.05),CRP的曲线下面积为0.821,ESR的曲线下面积为0.864,CRP为33.5 mg/m L时,灵敏度为81.5%,特异度为76.0%。当ESR为31.00 mm/h时,其灵敏度77.8%,特异度为92.0%。结论腰椎内固定术后中期检测血清CRP和ESR水平,可作为预测中期感染的重要参考指标。

Objective To evaluate value of serum C-reactive protein(CRP) and erythrocyte sedimentation rate(ESR) in predicting mid-term infection after lumbar spinal internal fixation.Methods Patients in our hospital with fever between 2 to 10 weeks after lumbar spinal internal fixation were selected,and were divided into infection group(group A) with 27 cases and the non-infection group(group B) with 25 cases according to the results of bacterial culture.Serum CRP and ESR level were compared,and the receiver-operating characteristic(ROC) curve was analyzed,the predictive value of mid-term infection of patients with fever was analyzed.Results In 27 confirmed cases,there were 7 cases with incision superficial infection,8 cases with incision deep infection,8 cases with pulmonary infection and 4 cases with urinary tract infection.Serum CRP and ESR in four types of infection of fever patients had statistically significant difference(P < 0.05).CRP and ESR in fever of group A were significantly higher than that of group B(P < 0.05).When the area under the curve of the CRP was 0.821,the ESR of the area under the curve was 0.864,when the CRP was 33.5 mg/m L,the sensitivity and the specificity were 81.5%,76.0%.When the ESR was 31.00 mm/h,the sensitivity and the specificity were 77.8%,92.0%,respectively.Conclusion The serum CRP and ESR levels of patients with fever after lumbar spinal internal fixation in mid-term stage can be used as important reference index of predicting infection.