PCT、CRP及ESR在脊柱手术后非感染患者中的变化规律

Study on the changes of procalcitonin,C reactive protein and ESR in non-infected patients after spinal surgery

目的研究降钙素原(procalcitonin,PCT)、C反应蛋白(C-reactionprotein,CRP)、血沉(erythrocyte sedimentation rate,ESR)在择期脊柱手术患者无感染并发症时的动态变化规律,比较三种炎症指标在早期判断择期脊柱手术后感染中的意义。方法研究对象为择期脊柱手术的83名患者(37名女性,46名男性)。与研究相关的临床变量包括年龄、性别、病史、手术时间及内植物。监测指标分别为体温、白细胞计数、ESR、CRP和PCT,分别在术前和术后第1、3、5天测定。结果ESR于手术后第3天开始明显升高,术后第5天仍具有升高趋势。PCT浓度峰值出现在术后第1天,与年龄、性别、糖尿病、高血压、手术时间及内植物使用无关。CRP浓度峰值出现在术后第3天,在老年、男性、糖尿病、高血压、较长的手术时间及内植物使用的患者中显著增高。结论与传统的炎症标志物ESR、CRP相比,PCT作为脊柱手术术后尤其是发热患者是否存在感染可能性的监测指标,具有更高的敏感性和特异性。PCT与CRP相比出现峰值的时间更早,根据变化趋势对于早期判断是否存在感染具有更高的时效性。

Objective:To compare the dynamic changes of procalcitonin(PCT),C reactive protein(CRP)and erythrocyte sedimentation rate(ESR)in patients with elective spinal surgery without infection complications,and to compare the three inflammatory markers in early diagnosis of postoperative infection after elective spinal surgery.Methods:Participants were 83 patients(37 women,46 men)who underwent elective spinal surgery.Clinical variables relevant to the study included age,sex,medical history,surgery duration and type of surgery.Clinical and laboratory data were body temperature(BT),white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and PCT,which were measured preoperatively and postoperatively on days 1,3,and 5.Results:ESR began to rise obviously at the third day after the operation,and still had an upward trend on the fifth day after the operation.The peak of PCT concentration appeared on the first day after operation,which was not related to age,sex,diabetes,hypertension,operation time and the use of instrumentation.The peak value of CRP was found at third days after the operation and increased significantly in the elderly,men,diabetes,hypertension,longer operating time,and the use of instrumentation.Conclusion:Compared with the traditional inflammatory markers of ESR and CRP,PCT has higher sensitivity and specificity as a monitoring indicator of the possibility of infection after spinal surgery,especially in patients with fever.The peak time of PCT is earlier than that of CRP.According to the trend of change,it has higher timeliness for early diagnosis of infection.