TNF-α与ESR和IL-6对慢性骨髓炎的诊断价值

Diagnostic value of TNF-α,ESR and IL-6 in chronic osteomyelitis

目的探讨肿瘤坏死因子-α(TNF-α)、红细胞沉降率(ESR)、白细胞介素-6(IL-6)对慢性骨髓炎(Chronic osteomyelitis,COM)患者合并感染的诊断价值,并分析主要病原菌的耐药性。方法选择丽水市中心医院骨科2016年5月-2019年5月收治的慢性骨髓炎感染患者80例作为研究组,分别选择同期接受治疗的非感染性慢性骨髓炎患者50例及健康体检者50名纳入非感染组及对照组。分析研究组患者病原菌分布特点及主要病原菌对常用抗菌药物的耐药性;比较三组血清TNF-α、ESR、IL-6水平并采用受试者工作特征曲线对其诊断价值进行评价。结果研究组患者共检出病原菌80株,其中革兰阳性菌48株占60.00%,革兰阴性菌32株占40.00%,以金黄色葡萄球菌为主;未检出对氨苄青霉素、万古霉素和替加环素耐药的金黄色葡萄球菌;研究组TNF-α、IL-6、ESR分别为(49.75±14.08)pg/ml、(21.27±6.34)pg/ml、(26.24±5.31)mm/h高于非感染组(29.31±12.43)pg/ml、(10.83±3.24)pg/ml、(16.48±4.27)mm/h及对照组(P<0.05);TNF-α、IL-6、ESR三项指标联合用于慢性骨髓炎患者感染的诊断曲线下面积(AUC)为0.894,特异度为86.95%,敏感度为84.30%,阳性预测值为86.24%,阴性预测值为61.57%,高于单指标检测水平(P<0.05)。结论临床中可多选择氨苄青霉素、万古霉素及替加环素进行金黄色葡萄球菌感染COM的抗菌治疗用药,TNF-α、IL-6、ESR三项指标联合对于COM合并感染具有较好的诊断价值。

OBJECTIVE To explore the characteristics of drug resistance and the diagnostic value of tumor necrosis factor-α(TNF-α), erythrocyte sedimentation rate(ESR), and interleukin-6(IL-6) in patients with chronic osteomyelitis infection, and analyze the drug resistance of major pathogens. METHODS A total of 80 patients with chronic osteomyelitis who were admitted to the Department of Orthopedics of Lishui Central Hospital from May 2016 to May 2019 were selected as the research group, 50 patients with non-infectious chronic osteomyelitis and 50 healthy subjects who received treatment during the same period were selected for inclusion non-infected group and control group, respectively. The distribution characteristics of pathogenic bacteria in the study group and the resistance of main pathogens to commonly used antibacterial drugs were analyzed;the serum TNF-α, ESR, and IL-6 levels of the three groups were compared and the receiver operating characteristic curve was used to evaluate their diagnostic value. RESULTS A total of 80 strains of pathogenic bacteria were detected in patients of the study group, of which 48 strains of Gram-positive bacteria accounted for 60.00%, 32 strains of Gram-negative bacteria accounted for 40.00%, mainly staphylococcus aureus;no S. aureus resistant to ampicillin, vancomycin and tigecycline were detected;TNF-α, IL-6, ESR of study group were(49.75±14.08)pg/ml,(21.27±6.34) pg/ml, and(26.24±5.31)mm/h, respectively, significantly higher than those of the non infection group(29.31±12.43)pg/ml,(10.83±3.24)pg/ml, and(16.48±4.27)mm/h respectively, and the control group(P<0.05);The area under the curve(AUC) of the three indicators of TNF-α, IL-6 and ESR used in the diagnosis of infection in patients with chronic osteomyelitis was 0.894, with specificity of 86.95% and sensitivity of 84.30%, the positive predictive value was 86.24%, and the negative predictive value was 61.57%, which was significantly higher than the single-index detection level(P<0.05). CONCLUSION In the clinic, ampicillin, vancomycin, and tigecycline can be used for the antibacterial treatment of S. aureus infection in COM. The combination of three indicators of TNF-α, IL-6, and ESR has good diagnostic value for COM infection.