儿童急性骨关节感染血清学检查的诊断价值

Serological indexes of children with acute osteoarticular infection

目的分析炎症相关指标对急性骨关节感染患儿的诊断价值。方法选取2017年7月-2019年12月河北省儿童医院急诊外科收治的骨关节术后患儿105例,根据术后是否发生急性骨关节感染分为感染组(n=43)和未感染组(n=62)。比较两组患儿一般资料,统计术前和术后3 d、7 d的血沉(ESR)、全血白细胞(WBC)、血清C-反应蛋白(CRP)、降钙素原(PCT)、淀粉样蛋白A(SAA)、和不同感染类型患儿ESR、全血WBC和血清CRP、PCT、SAA水平,分析ESR、全血WBC和血清CRP、PCT、SAA对儿童急性骨关节感染的诊断价值。结果术后3 d、7 d与术前比较,两组患儿ESR、全血WBC和血清CRP、PCT、SAA水平均升高(P<0.05),感染组高于未感染组(P<0.05)。术后3 d,混合感染患儿ESR和血清CRP、PCT、SAA水平均高于骨髓炎患儿和化脓感染患儿(P<0.05)。PCT对儿童急性骨关节感染敏感性高于其他指标(P<0.05)。结论 ESR、全血WBC和血清CRP、PCT、SAA对急性骨关节感染均有较好的诊断价值,其中PCT对急性骨关节感染的诊断价值最高。

OBJECTIVE To analyze the diagnostic value of inflammation-related indicators in children with acute bone and joint infection. METHODS The clinical data of 105 children admitted to the department of articular surgery in Hebei children’s hospital between Jul. 2017 and Dec. 2019 after emergency surgery were collected. All subjects were were divided into the infected group(43 cases) and uninfected group(62 cases) according to the occurrence of acute osteoarticular infection after surgery. The general data of the two groups of children were compared. The levels of blood sedimentation(ESR), white blood cells(WBC), whole blood, serum C-reactive protein(CRP), calcitonin(PCT) and amyloid A(SAA) 3 days before operation, 3 days and 7 days after operation were compared. The levels of ESR, whole blood WBC, serum CRP, PCT and SAA among different types of infection were compared. The diagnostic value of ESR, whole blood WBC, serum CRP, PCT and SAA on acute bone and joint infection in children was analyzed. RESULTS The levels of ESR, whole blood WBC and serum CRP, PCT and SAA in the two groups were all increased 3 d and 7 d after surgery compared with that before surgery(P<0.05);levels in the infection group was significantly higher than that in the non-infection group(P<0.05). Three days after the operation, the levels of ESR, serum CRP, PCT and SAA in children with mixed infection were significantly higher than that in children with osteomyelitis and with suppurative infection(P<0.05). The sensitivity of PCT to acute bone joint infection in children was significantly higher than that of other indexes(P<0.05). CONCLUSION ESR, whole blood WBC, serum CRP, PCT and SAA have good diagnostic value for acute bone joint infection, among which PCT has the highest diagnostic value.