血清中性粒细胞载脂蛋白在骨科感染性疾病的表达及其临床意义

The diagnostic value of serum human neutrophilic apolipoprotein in infectious diseases of orthopedics

目的通过比较骨科疾病中中性粒细胞载脂蛋白(HNL)、白细胞(WBC)及中性粒细胞(NBC)计数、降钙素原(PCT)、血沉(ESR)、C反应蛋白(CRP)水平差异,探讨HNL水平在鉴别骨科感染性疾病中的意义.方法随机选取郑州大学第一附属医院骨科病例245例,其中脊柱关节退变性疾病、闭合性骨折、骨骼软组织肿瘤等非感染性病例185例,骨髓炎、各种术后感染、慢性溃疡等感染性病例60例,分别测定血清学HNL水平、白细胞及中性粒细胞计数、PCT、ESR、CRP水平,分析两组患者血清中HNL、白细胞及中性粒细胞计数、PCT、ESR、CRP水平差异,采用受试者工作特征(ROC)曲线评价HNL、白细胞及中性粒细胞计数、PCT、ESR、CRP水平对骨科感染性疾病的诊断效能.计量资料以均值±标准差(Mean±SD)表示,炎性指标组间比较采用独立样本t检验.结果 HNL水平:非感染组141.28±63.11,感染组229.96±107.62,差异有统计学意义(t=-7.819,P<0.05);白细胞计数:非感染组6.18±1.45,感染组7.39±3.91,差异有统计学意义(t=-3.524,P<0.05);中性粒细胞计数:非感染组3.72±1.32,感染组5.17±3.85,差异有统计学意义(t=-4.421,P<0.05);PCT水平:非感染组0.04 ±0.12,感染组0.36±1.03,差异有统计学意义(t=-3.666,P<0.05);ESR水平:非感染组11.06±11.69,感染组24.16±24.87,差异有统计学意义(t=-5.538,P<0.05);CRP水平:非感染组6.22±11.86,感染组20.33±26.27,差异有统计学意义(t=-5.736,P<0.05).计算受试者工作特征(ROC)曲线下面积(AUC):AUCHNL(0.777)>AUCESR(0.752)> AUCCRP (0.676)>AUCPCT (0.534)>AUCNBC (0.528)>AUCWBC(0.481);HNL诊断骨科感染性疾病的截断值为120.1 μg/L.结论 HNL可作为骨科疾病中鉴别感染与非感染参考指标,效能优于传统的白细胞及中性粒细胞计数、ESR、CRP等.

Objective To study the serum human neutrophilic apolipoprotein (HNL), white blood cell (WBC) and neutrophil counts, procalcitonin (PCT), ESR and C-reactive protein (CRP) levels in orthopaedic diseases, and to explore the significance of HNL levels in the identification of infectious diseases in orthopaedic diseases. MethodsOrthopaedic diseases were selected from Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, including 185 non-infectious cases (spinal and joint degenerative disease, closed fractures, bone and soft tissue tumor), and 60 infectious cases (osteomyelitis, various postoperative infection and chronic ulcer). Serum HNL level, WBC and neutrophil counts, PCT, ESR and CRP levels were determined, and statistically analyzed. The diagnostic efficacy of HNL, WBC and neutrophil counts, PCT, ESR and CRP levels in orthopedic infectious diseases was evaluated by ROC curves. ResultsLevels of HNL: non-infected group 141.28±63.11 and the infected group 229.96±107.62, the difference was statistically significant (t=-7.819, P<0.05);WBC: non-infected group 6.18±1.45 and the infected group 7.39±3.91, the difference was statistically significant (t=-3.524, P<0.05);neutrophil counts: non-infected group 3.72±1.32 and the infected group 5.17±3.85, the difference was statistically significant (t=-4.421, P<0.05);levels of PCT: non-infected group 0.04±0.12 and the infected group 0.36±1.03, the difference was statistically significant (t=-3.666, P<0.05);levels of ESR: non-infected group 11.06±11.69 and the infected group24.16±24.87, the difference was statistically significant (t=-5.538, P<0.05);levels of CRP: non-infected group 6.22±11.86 and the infected group20.33±26.27, the difference was statistically significant (t=-5.736, P<0.05). Area under ROC curve: AUCHNL (0.777)>AUCESR (0.752)>AUCCRP (0.676)>AUCPCT (0.534)>AUCNBC (0.528)>AUCWBC (0.481). The HNL cut-off value for the diagnosis of bone infectious diseases was 120.1 μg/L. ConclusionHNL can be used as a reference index to distinguish infection from non-infection in orthopaedic diseases, and its efficacy is better than the traditional white blood cell and neutrophil count, ESR, CRP and PCT.