血清CRP、PCT、IL-6及ESR水平变化对急性骨髓炎的临床意义

Clinical significance of changes of serum CRP,PCT,IL-6 and ESR on acute osteomyelitis

目的探讨急性骨髓炎血清C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)及血沉(ESR)指标变化及临床意义。方法选取2016年1月~2019年5月我院收治的急性骨髓炎患者105例为研究对象,随访1年,预后评分<4分为预后不良组(34例),评分≥4分为预后良好组(71例),另选取本院同期健康体检者60例为对照组。比较对照组和急性骨髓炎患者手术前后血清CRP、PCT、IL-6、ESR水平,进行影响患者预后的多因素分析,并应用受试者工作特征曲线(ROC)比较联合检测与单独检测的曲线下面积(AUC)。结果骨髓炎组血清CRP、PCT、IL-6、ESR水平均高于对照组(P<0.05);预后良好组患者手术后血清CRP、PCT、IL-6、ESR水平均低于手术前(P<0.05);预后不良组患者手术后血清CRP、PCT、IL-6、ESR水平均低于手术前(P<0.05);CRP(OR=4.918)、PCT(OR=6.038)、IL-6(OR=5.270)、ESR(OR=3.877)升高是急性骨髓炎患者预后不良的独立危险因素(P<0.05);CRP+PCT+IL-6+ESR联合检测的AUC大于单独检测。结论CRP、PCT、IL-6、ESR可能与急性骨髓炎发生发展密切相关,可作为其预后的预测指标,四者联合检测预测效能更高。

Objective To explore the changes and clinical significance of serum C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)and erythrocyte sedimentation rate(ESR)in acute osteomyelitis.Methods 105 patients with acute osteomyelitis admitted to our hospital from January 2016 to May 2019 were enrolled in osteomyelitis group.At 1 year of follow-up,the patients with prognosis score<4 points were included in poor prognosis group(34 cases),and the patients with score≥4 points were set as good prognosis group(71 cases).60 healthy people with physical examination at the same period were selected as control group.The levels of serum CRP,PCT,IL-6 and ESR were measured before and after surgery in control group and patients with acute osteomyelitis.Multivariate analysis of prognosis was performed,and the area under the curve(AUC)of combined detection and individual detection was compared using the receiver operating characteristic curve(ROC).Results The levels of serum CRP,PCT,IL-6 and ESR in osteomyelitis group were higher than those in control group(P<0.05).The levels of serum CRP,PCT,IL-6 and ESR in good prognosis group were lower than those before surgery(P<0.05).The levels of serum CRP,PCT,IL-6 and ESR in poor prognosis group were lower than those before surgery(P<0.05).CRP(OR=4.918),PCT(OR=6.038),IL-6(OR=5.270)and ESR(OR=3.877)were independent risk factors for poor prognosis in patients with acute osteomyelitis(P<0.05).The AUC of combined detection of CRP+PCT+IL-6+ESR was greater than that of individual detection.Conclusion CRP,PCT,IL-6 and ESR may be closely related to the occurrence and development of acute osteomyelitis,and they can be used as predictors of prognosis,and the combined detection of the four has higher predictive efficacy.