血清胆碱酯酶、可溶性白细胞分化抗原-14、C反应蛋白与骨折术后感染相关性及临床预测价值分析

Correlation of serum cholinesterase,soluble leukocyte differentiation antigen-14 and C-reactive protein with postoperative infection after fracture surgery and their clinical predictive value

目的探究血清胆碱酯酶、可溶性白细胞分化抗原-14(sCD14)、C反应蛋白(CRP)与骨折术后感染相关性及临床预测价值。方法回顾性分析2017年3月至2019年7月淇县人民医院手术治疗的116例开放性骨折病人的临床资料,根据是否发生术后感染分为观察组(感染病人)53例,对照组(未感染病人)63例。研究两组病人的基线资料及术后1 d血清胆碱酯酶、sCD14、CRP水平,采用logistic回归分析骨折术后感染的危险因素,受试者工作特征(ROC)曲线分析血清各指标对术后感染的早期诊断价值。同时比较不同预后感染病人的基线资料及感染时、治疗2周、4周后各血清各指标水平,采用logistic回归分析骨折术后感染预后的影响因素,探讨治疗2周后的血清各指标水平对预后不良的预测价值。结果观察组手术时间(131.07±10.03)min长于对照组(108.45±10.57)min,术后1 d血清胆碱酯酶(4846.23±1355.07)U/L、sCD14(2.46±0.78)mg/L、CRP(96.54±23.49)mg/L高于对照组(3562.71±1290.69)U/L、(1.71±0.70)mg/L、(75.16±21.55)mg/L(均P<0.05);logistic回归显示,手术时间、术后1 d血清胆碱酯酶、sCD14、CRP水平升高均是开放性骨折术后感染的独立危险因素(P<0.05);ROC分析显示,术后1 d血清胆碱酯酶、sCD14、CRP对骨折术后感染诊断的曲线下面积(AUC)值均>0.7,具有较好的诊断价值,其中术后1 d血清胆碱酯酶、CRP诊断的灵敏度更高(69.81%),而sCD14诊断的特异度更高(90.48%);血清胆碱酯酶与sCD14、CRP水平呈正相关,血清sCD14与CRP呈正相关(P<0.05)。对术后感染病人进行3个月的随访,19例预后不良,34例预后良好;合并糖尿病、治疗2周后血清胆碱酯酶、sCD14、CRP水平升高是骨折术后感染病人预后不良的独立危险因素(P<0.05);ROC曲线分析显示,治疗2周的血清胆碱酯酶、sCD14、CRP水平对开放性骨折术后感染病人临床预后具有较好的预测价值(AUC均>0.7)。结论开放性骨折术后感染病人血清胆碱酯酶、sCD14、CRP水平显著升高,术后早期检测有助于感染的早期诊断。治疗2周后血清胆碱酯酶、sCD14、CRP水平对骨折术后感染病人预后具有较好的预测价值。

Objective To explore the correlation of serum cholinesterase,soluble leukocyte differentiation antigen-14(sCD14),C-reactive protein(CRP)with postoperative infection of fracture patients and their clinical predictive value.Methods The clinical data of 116 patients with open fractures treated in People's Hospital of Qi County from March 2017 to July 2019 were retrospectively analyzed.According to whether postoperative infection occurred,they were assigned into observation group(infected patients)with 53 cases and control group(uninfected patients)with 63 cases.The baseline data and the levels of serum cholinesterase,sCD14 and CRP on the first day after operation of the two groups were studied.The risk factors for postoperative infection were analyzed by logistic regression.The early diagnostic value of serum indicators for postoperative infection was analyzed by receiver operating characteristic(ROC)curve.At the same time,the baseline data and serum levels of indicators in patients when getting infection,2 weeks and 4 weeks after treatment were compared.Logistic regression was used to analyze the prognostic influence factors for infection after fracture surgery,and to explore the predictive value of serum levels of indicators for poor prognosis 2 weeks after treatment.Results The operation time of the observation group was(131.07±10.03)min,which was longer than that of the control group(108.45±10.57)min.The levels of serum cholinesterase,sCD14,and CRP in the observation group 1 d after treatment were higher than those in the control group[(4846.23±1355.07)U/L vs.(3562.71±1290.69)U/L,(2.46±0.78)mg/L vs.(1.71±0.70)mg/L,(96.54±23.49)mg/L vs.(75.16±21.55);all P<0.05].Logistic regression analysis results showed that the operation time and the increased levels of serum cholinesterase,sCD14 and CRP on the first day after operation were independent risk factors for postoperative infection of open fractures(P<0.05).ROC analysis showed that the area under the curve(AUC)values of serum cholinesterase,sCD14 and CRP on the first day after operation were all greater than 0.7,which had good diagnostic value.Among them,the sensitivity of serum cholinesterase and CRP on the first day after surgery was higher(69.81%),while the diagnostic specificity of sCD14 was higher(90.48%).Serum cholinesterase was positively correlated with sCD14 and CRP levels,and serum sCD14 was positively correlated with CRP(P<0.05).The postoperative infection patients were followed up for 3 months.Nineteen cases had a poor prognosis and 34 cases had a good prognosis.Combined diabetes,increased serum cholinesterase,sCD14,and CRP levels 2 weeks after treatment were the independent risk factors for poor prognosis(P<0.05).ROC curve analysis showed that serum cholinesterase,sCD14,and CRP levels 2 weeks after treatment had a good predictive value for the clinical prognosis(all AUC>0.7).Conclusions The levels of serum cholinesterase,sCD14 and CRP in patients with infection after open fracture operation were significantly increased.Early detection after operation is helpful for early diagnosis of infection.The levels of serum cholinesterase,sCD14 and CRP 2 weeks after treatment have a good predictive value for the prognosis of patients with infection after fracture surgery.