中性粒细胞指数、降钙素原和C-反应蛋白在四肢闭合性骨折术后早期感染中的诊断价值

Diagnostic value of procalcitonin,neutrophil index and C-reactive protein in early postoperative infection of closed limb fractures

目的研究中性粒细胞指数(CD64指数)、降钙素原(PCT)及C-反应蛋白(CRP)在四肢闭合性骨折术后早期感染的诊断价值。方法选取本院骨科2009年1月-2017年7月住院手术治疗的闭合性骨折术后感染患者22例,采用流式细胞术检测外周血中性粒细胞膜表面CD64表达水平,ELISA法和免疫透射比浊法测定血清中PCT及CRP的含量,制作ROC曲线分析三者在四肢闭合性骨折术后早期感染的诊断价值。结果四肢闭合性骨折术后发生感染患者的CD64指数、PCT、CRP在术后1 d、3 d和7 d明显高于手术前。CD64 ROC曲线下面积为0.932 8,明显高于PCT和CRP。当CD64指数截断值为5.696%时,其诊断灵敏度和特异度均优于CRP和PCT,三者联合应用时,灵敏度和特异度有明显提高。结论联合CD64指数、PCT及CRP检测对提高四肢闭合性骨折术后早期感染诊断的灵敏度和特异度具有重要价值,有助于临床早期诊断及早期治疗。

Objective To study the diagnostic value of procalcitonin（PCT）,neutrophil index（CD64） and C-reactive protein（CRP） in early postoperative infection of limb closed fractures. Methods Twenty-two patients with closed fractures were enrolled in our hospital from January 2009 to July 2017. The expression of CD64 on the peripheral blood neutrophils was detected by flow cytometry. Enzyme-linked immunosorbent assay（ELISA） and immunodiffusion were used to detect the contents of PCT and CRP. The ROC curve was prepared and used to analyze the diagnostic value of early infections after closed limb fractures.Results The levels of CD64 index,PCT and CRP at 1 d,3 d,7 d after operation were significantly higher than those before operation. The area under ROC curve of CD64 was 0. 932 8,which was significantly higher than that of PCT and CRP. When the cut-off value of CD64 index was 5. 696%,the diagnostic sensitivity and specificity were better than those of CRP and PCT. When the three were combined,sensitivity and specificity were significantly improved. Conclusion The combination of CD64 index,PCT and CRP detection is of great value in improving the diagnostic sensitivity and specificity of early postoperative infection of closed limb fractures,which is helpful for the early diagnosis and treatment.