D-二聚体在艾滋病患者全髋置换术后感染的变化

Variation of D-dimer in surgical site infection after total hip arthroplasty in AIDS patients

[目的]评价艾滋病患者全髋置换术后感染(surgical site infection,SSI)D-二聚体(D-dimer,DD)的变化。[方法]回顾性分析2015年1月-2020年9月在本院行全髋置换术的60例艾滋病患者的临床资料,根据是否发生SSI将患者分为感染组和非感染组。分别于术前和术后1、3、7 d检测DD、CRP和ESR,分析DD与ESR和CRP的相关性,并行受试者工作特征曲线ROC分析。[结果]60例HIV阳性患者中,有11例发生SSI,发生率为18.33%。术前两组DD、CRP、ESR比较,差异无统计学意义(P>0.05);术后1 d,感染组DD显著高于未感染组(P<0.05);术后3 d,两组间DD的差异无统计学意义(P>0.05);术后7 d,感染组的DD再次显著高于未感染组(P<0.05)。Pearson相关分析结果显示,艾滋病患者术前和术后7 d,DD与ESR和CRP水平均呈显著正相关(P<0.05),而术后1 d和术后3 d,呈显著负相关(P<0.05)。ROC分析,曲线下面积(area under cure,AUC)为0.93,准确性87.54%,特异性86.76%,阳性预测率79.42%,阴性预测率94.58%。[结论]艾滋病患者全髋关节置换术后SSI早期,DD明显升高,可作为艾滋病患者全髋置换SSI的早期预警指标。

[Objective]To evaluate the variation of D-dimer(DD)in surgical site infection(SSI)secondary to total hip arthroplasty in AIDS patients.[Methods]A respective study was done on 60 AIDS patients who underwent total hip replacement in our hospital from January 2015 to September 2020.Based on whether or not SSI happened,the patients were divided into SSI and non-SSI groups.The DD,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were assayed before operation and at 1,3,and 7 days postoperatively.The correlation between DD and ESR or CRP was searched,and the predicating value of DD for SSI was analyzed by receiver operating characteristic(ROC)curve.[Results]Among the 60 HIV-positive patients,11 cases proved of SSI with incidence rate of 18.33%.There was no significant difference in DD,CRP,ESR between the two groups before operation(P>0.05).However,the SSI group had significantly higher DD than the non-SSI group at 1 day after operation(P<0.05),which became not statistically significant at 3 days after operation(P>0.05),and then turned to be statistically significant again at 7 days postoperatively(P>0.05).As result of Pearson correlation analysis,DD was significantly positively correlated with ESR and CRP levels before operation and at 7 days after operation(P<0.05),while became significantly negatively correlated with them at 1 and 3 days after surgery(P<0.05).Regarding ROC analysis,the area under cure(AUC)was of 0.93,with accuracy of 87.54%,specificity of 86.76%,the positive prediction rate of 79.42%,and the negative prediction rate of 94.58%.[Conclusion]In the early stage of SSI after total hip replacement in AIDS patients,DD is significantly increased,which might be used as an early warning indicator for SSI in AIDS patients.