PCT联合CRP不同时间检测对提高骨折术后感染灵敏度与特异性的价值

Value of PCT Combined with CRP Detection at Different Times in Improving Infection Sensitivity and Specificity after Fracture Surgery

目的:探讨血清降钙素(PCT)联合超敏C反应蛋白(CRP)不同时间检测对提高骨折术后感染灵敏度与特异性的价值。方法:选取2014年7月至2016年7月期间于我院行骨折手术治疗后手术部位发生感染与未发生感染的188例患者作为研究对象,将感染患者作为观察组,未感染患者作为对照组。分别于术后第1、5、10天对PCT、CRP水平进行检测,评估两组患者术后感染的灵敏度与特异性。结果:两组术后第1天,PCT和CRP均无明显差异(P>0.05),观察组术后第5和第10天PCT和CRP均明显高于对照组(P<0.05);观察组患者在术后第4天之前PCT持续升高并达到高峰,与较前相比变化显著(P<0.05),而之后随着感染得以控制,随着恢复好转,PCT浓度会逐渐下降,期间CRP始终持续上升,直至第10天达到高峰,要迟于PCT;PCT对骨折术后患者感染诊断的灵敏度和特异性要高于CRP,同时PCT联合CRP诊断的感染灵敏度和特异性均要高于分别独立诊断(P<0.05)。结论:PCT联合CRP不同时间检测能显著提高骨折术后感染的诊断准确度,为临床相关预防治疗及抗生素合理应用提供有效的参考价值。

Objective:To explore the value of different time detection of serum calcitonin combined with hypersensitive c-reactive protein in improving the sensitivity and specificity of postoperative infection of fractures.Methods:From July 2014 to July 2016,188 patients with or without infection at the surgical site after fracture surgery in our hospital were selected as the study subjects.The infected patients were treated as the observation group and the uninfected patients as the control group.Serum calcitonin(PCT)and hypersensitive c-reactive protein(CRP)levels were measured on the 1st,5th and 10th day after surgery,respectively,to assess the sensitivity and specificity of postoperative infection in the two groups.Results:There was no significant difference in PCT and CRP between the two groups on the first day after surgery(P>0.05).In the observation group,PCT continued to rise and reach a peak before the 4th day after the operation,with significant changes compared with the previous period(P<0.05).Afterwards,as the infection was controlled and recovered,the concentration of PCT gradually decreased.During this period,CRP continued to rise until the peak reached on the 10th day,later than PCT.The sensitivity and specificity of PCT in the diagnosis of infection after fracture surgery were higher than CRP,and the sensitivity and specificity of PCT combined with CRP in the diagnosis of infection were higher than that of independent diagnosis(P<0.05).Conclusions:PCT combined with CRP at different time can significantly improve the diagnostic accuracy of postoperative infection of fracture,and provide an effective reference value for clinical prevention and treatment and rational application of antibiotics.