髋关节置换术后假体周围感染诊断指标研究

Indexes for diagnosis of periprosthetic infection in hip arthroplasty patients

目的探讨血清神经肽Y(Neuropeptide Y,NPY)、β-内啡肽(β-endorphin,β-EP)、粒细胞集落刺激因子(Granulocyte colony stimulating factor,G-CSF)、白细胞介素-6(Interleukin-6,IL-6)对髋关节置换术后感染的诊断意义。方法选取2017年6月-2019年7月医院收治的30例髋关节置换术感染患者作为感染组,选取未感染者105例作为未感染组,比较两组血清C-反应蛋白(C-reactive protein,CRP)、白细胞计数(White blood cell,WBC)、血沉(Erythrocyte sedimentation rate,ESR)、NPY、β-EP、G-CSF、IL-6水平,采用受试者工作特征曲线(Receiver operating characteristic,ROC)及曲线下面积(Area under the curve,AUC)分析血清各指标预测感染的价值,并比较细菌感染与真菌感染者血清NPY、β-EP、G-CSF、IL-6水平,分析各指标鉴别细菌感染的价值。结果感染组血清CRP、WBC、ESR水平较未感染组高(P<0.05);感染组血清NPY、β-EP、G-CSF、IL-6水平较未感染组高(P<0.05);G-CSF预测感染的AUC最高,最佳截断值为54.37 ng/L(P<0.05);细菌感染者血清G-CSF、IL-6水平较真菌感染者高(P<0.05);IL-6鉴别细菌感染的AUC高于G-CSF,最佳截断值为148.75 pg/ml,敏感度、特异度分别为80.95%、88.89%(P<0.05)。结论髋关节置换术后感染患者血清NPY、β-EP、G-CSF、IL-6处于高表达状态,对疾病具有较高诊断价值,G-CSF、IL-6还可用于病原体的鉴别。

OBJECTIVE To explore the diagnostic significance of serum neuropeptide Y(NPY),β-endorphin(β-EP),granulocyte colony stimulating factor(G-CSF)and interleukin-6(IL-6)in the infection of patients after hip replacement.METHODS Thirty patients with hip arthroplasty admitted to our hospital from June 2017 to July 2019 were enrolled as the infected group,and 105 uninfected patients were recruited as the uninfected group.The levels of serum C-reactive protein(CRP),white blood cell count(WBC),erythrocyte sedimentation rate(ESR),NPY,β-EP,G-CSF,IL-6 between the two groups were compared.Receiver operating characteristic(ROC)curve and area under the curve(AUC)of serum indicators were used to evaluate the value to predict the infection.And levels of the serum NPY,β-EP,G-CSF,IL-6 in bacterial infections and fungal infections were compared,to analyze the value of various indexes for the identification of bacterial infections.RESULTS The levels of serum CRP,WBC and ESR in the infected group were significantly higher than that in the uninfected group(P<0.05).The levels of serum NPY,β-EP,G-CSF and IL-6 in the infected group were significantly higher than that in the uninfected group(P<0.05).The AUC of G-CSF for the infection identification was the highest,with the cut-off value of 54.37 ng/L(P<0.05).The levels of serum G-CSF and IL-6 in patients with bacterial infection were significantly higher than that in patients with fungal infection(P<0.05).The AUC of IL-6 was higher than that of G-CSF,and the cut-off value was 148.75 pg/ml,with the sensitivity and specificity of 80.95%and 88.89%,respectively(P<0.05).CONCLUSION The serum levels of NPY,β-EP,G-CSF and IL-6 in patients with hip joint replacement were highly expressed,which had high diagnostic value for diseases.G-CSF and IL-6 can also be used for pathogen identification.