老年股骨转子间骨折患者围手术期程序性死亡受体-1表达水平在判断术后感染中的作用

Expression of programmed death receptor-1 and its prediction of postoperative infectious complications in elderly patients with hip fracture

目的探讨老年股骨转子间骨折患者围手术期程序性死亡受体-1(PD-1)表达与感染的关系及预警价值。方法前瞻性招募2015年8月至2016年8月期间解放军总医院第七医学中心骨科收治的119例老年股骨转子间骨折患者(观察组),男86例,女33例;年龄为(80.7±8.1)岁。选取20例无外伤及严重内科疾病的轻度膝关节骨关节炎患者为对照组。观察组患者采用闭合复位股骨近端髓内钉固定治疗,监测患者术前、术后1、3、5 d外周血T细胞PD-1的表达变化,并根据随访期间是否发生感染分为感染组和无感染组,比较两组患者术前、术后1、3、5 d PD-1的表达变化,分析PD-1表达与感染的关系,评估其预警价值。结果观察组与对照组、感染组与无感染组患者临床基线情况比较差异均无统计学意义(P>0.05),具有可比性。与对照组患者比较,观察组患者术前、术后1、3、5 d PD-1表达显著增高,差异均有统计学意义(P<0.05)。感染组(24例)患者术后1、3、5 d PD-1表达(33.60%±2.44%、35.68%±4.05%、30.36%±4.42%)显著高于无感染组(95例)患者(29.57%±3.20%、21.45%±2.20%、20.94%±2.30%),差异均有统计学意义(P<0.05)。感染组患者PD-1表达在术后3 d达高峰,术后5 d仍未降至术前水平;而无感染组患者PD-1表达仅在术后1 d呈一过性增高。观察组患者术后3 d与术后1 d PD-1表达的差值预测感染并发症的临界值为3.4%,其预测的敏感性和特异性分别为95.6%、92.6%。结论老年股骨转子间骨折患者髓内钉固定术后PD-1表达显著增高,感染患者PD-1表达较无感染患者增高幅度大,持续时间长;术后3 d与术后1 d PD-1表达的差值预测术后28 d内感染发生的敏感性和特异性均较高。

Objective To investigate the expression of programmed death receptor-1(PD-1)and its value in predicting the infectious complications in elderly patients with hip fracture.Methods A total of 119 elderly patients with intertrochanteric fracture(observation group)were prospectively enrolled for this study from August 2015 to August 2016 at Department of Orthopaedics,The Seventh Medical Center of PLA.They were 86 males and 33 females with an age of 80.7±8.1 years.Another 20 elderly out-patients with gonarthritis but without trauma or major medical disease were enrolled as a control group.The observation group received closed reduction and internal fixation with proximal femoral intramedullary nails.The PD-1 expression in peripheral blood T cells was detected at preoperation,1,3 and 5 days postoperation in the patients of observation group.They were further divided into an infection group and a non-infection group depending on whether infectious complications occurred during the follow-up period.The association between PD-1 and infectious complications was analyzed and its predictive value was calculated.Results The observation group and the control group,as well as the infection group and the non-infection group,were compatible due to their insignificant differences in baseline data(P>0.05).Compared with the control group,the expression of PD-1 in the peripheral blood T cells in the observation group was all significantly increased at preoperation,1,3 and 5 days postoperation(P<0.05).The PD-1 expression in patients of the infection group(24 cases)increased significantly higher at 1,3 and 5 days postoperation(33.60%±2.44%,35.68%±4.05%and 30.36%±4.42%)than in those of the non-infection group(29.57%±3.20%,21.45%±2.20%and 20.94%±2.30%)(P<0.05).The PD-1 expression in the infection group reached its peak at 3 days postoperation and did not fall to the preoperative level at 5 days postoperation.However,the PD-1 expression in patients of the non-infection group(95 cases)showed a transient rise only on the first day postoperation.The cutoff value of the difference in PD-1 expression between 1 and 3 days postoperation that could predict the infectious complications was 3.4%,with a sensitivity of 95.6%and a specificity of 92.6%.Conclusions The expression of PD-1 may significantly increase after intramedullary fixation of hip fracture in elderly patients.The patients with infectious complications may exhibit a greater and longer increase in PD-1 expression than those without infectious complications.The difference in PD-1 expression between 1 and 3 days postoperation has a good predictive value for infectious complications because its high sensitivity and specificity.