血清PCT、hs-CRP联合ESR在四肢骨折内固定术后早期发热患者继发感染中的预测价值

Prediction of secondary infection in patients with early fever after internal fixation of limb fractures by serum PCT,hs-CRP and ESR

目的分析血清降钙素原(PCT)、高敏-C反应蛋白(hs-CRP)联合红细胞沉降率(ESR)在四肢骨折内固定术后早期发热患者继发感染中的预测价值。方法回顾性分析2017年1月—2020年10月连云港市第二人民医院急诊外科收治的198例四肢骨折内固定术后患者(骨折术后组)和182例同年龄段健康志愿者(健康志愿组)资料。骨折术后组男性104例,女性94例;年龄20~78岁,平均52.5岁;道路交通伤101例,高处坠落伤46例,跌倒伤30例,殴打伤21例。健康志愿组男性98例,女性84例;年龄20~78岁,平均51.5岁。骨折术后组于术后48h抽取外周静脉血,健康志愿组采用体检剩余外周静脉血。分别采用酶联荧光法、全程C反应蛋白定量测试剂盒、全自动血沉仪检测血清PCT、hs-CRP及ESR水平,并比较两组差异。比较骨折术后组开放骨折、闭合骨折术后早期发热与未发热患者、术后早期发热患者中继发感染和未继发感染患者的血清PCT、hs-CRP及ESR水平,分析术后感染的影响因素,以及血清PCT、hs-CRP、ESR水平联合预测骨折术后组术后早期发热患者继发感染的灵敏度、特异度、曲线下面积(AUC)。结果骨折术后组中术后早期发热者占比38.9%(77/198),其中继发感染者占比38%(29/77),术后感染率为14.6%(29/198);骨折术后组术后血清PCT、hs-CRP及ESR水平均高于健康志愿组(3.52±0.75)μg/L vs.(0.48±0.08)μg/L,(10.69±2.15)mg/L vs.(2.10±0.41)mg/L,(26.41±4.55)mm/h vs.(10.52±2.12)mm/h,骨折术后组中术后早期发热患者血清PCT、hs-CRP及ESR水平均高于未发热患者(5.97±1.69)μg/L vs.(1.96±0.37)μg/L,(19.25±3.35)mg/L vs.(5.24±1.03)mg/L,(42.95±7.83)mm/h vs.(15.88±3.12)mm/h,术后早期发热患者中继发感染者血清PCT、hs-CRP及ESR水平均高于未感染者(6.25±1.72)μg/L vs.(2.04±0.39)μg/L,(21.30±3.40)mg/L vs.(5.65±1.09)mg/L,(70.25±9.41)mm/h vs.(26.46±5.02)mm/h,差异均有统计学意义(P<0.05)。开放性骨折、闭合性骨折患者中上述指标变化趋势均一致;受伤至手术时间、开放性骨折、≥2次手术均为术后感染的危险因素(P<0.05),按无菌术标准执行是其保护因素(P<0.05);血清PCT、hs-CRP及ESR水平联合预测四肢骨折内固定术后早期发热患者继发感染的特异度、AUC均高于单独预测。结论四肢骨折内固定术后血清PCT、hs-CRP及ESR水平普遍偏高,术后早期发热患者上述指标水平更高,尤其是继发感染患者,三者联合对此类患者继发感染的预测效能高于单独检测。

Objective To analyze the predictive value of serum procalcitonin(PCT),high-sensitivity-c-reactive protein(hs-CRP)and erythrocyte sedimentation rate(ESR)in patients with early fever after internal fixation of limb fractures.Methods The data of 198 patients with limb fractures treated by internal fixation and 182 healthy volunteers of the same age were analyzed retrospectively.They were recorded as fracture group[104 males and 94 females;average age 52.5(20-78)years;causes of injury:101 cases of traffic accidents,46 cases of falling injuries,30 cases of falls and 21 cases of fights]and health volunteer group[98 males and 84 females;average age 51.5(20-78)years],respectively.Peripheral venous blood was taken 48 hours after operation in the fracture group,and the remaining peripheral venous blood was taken in the healthy volunteer group.The levels of serum PCT,hs-CRP and ESR were detected by enzyme-linked fluorescence method,whole course C-reactive protein quantitative test kit and automatic ESR analyzer,and the differences between the fracture group and the healthy volunteer group were compared.The serum PCT,hs-CRP and ESR levels of fracture group and health volunteer group were compared.In the fracture group,the serum PCT,hs-CRP and ESR levels were compared between patients with early postoperative fever and those without fever.The serum PCT,hs CRP and ESR levels were compared between patients with recurrent infection and patients without secondary infection.The influencing factors of postoperative infection were analyzed.The serum PCT,hs-CRP and ESR levels to predict the sensitivity,specificity,area under curve(AUC)of secondary infection in patients with early postoperative fever in fracture postoperative group were analyzed.Result In the fracture group,38.9%(77/198)of the patients had fever in early stage,38%(29/77)of them had secondary infection,and 14.6%(29/198)of them had postoperative infection.The levels of PCT,hs-CRP and ESR in the fracture postoperative group were higher than those in the health volunteer group[(3.52±0.75)μg/L vs.(0.48±0.08)μg/L,(10.69±2.15)mg/L vs.(2.10±0.41)mg/L,(26.41±4.55)mm/h vs.(10.52±2.12)mm/h].In the fracture group,the levels of PCT,hs-CRP and ESR in patients with early postoperative fever were higher than those in patients without fever[(5.97±1.69)μg/L vs.(1.96±0.37)μg/L,(19.25±3.35)mg/L vs.(5.24±1.03)mg/L,(42.95±7.83)mm/h vs.(15.88±3.12)mm/h].The levels of serum PCT,hs-CRP and ESR in patients with recurrent infection were higher than those in uninfected patients[(6.25±1.72)μg/L vs.(2.04±0.39)μg/L,(21.30±3.40)mg/L vs.(5.65±1.09)mg/L,(70.25±9.41)mm/h vs.(26.46±5.02)mm/h].The differences were statistically significant(P<0.05).The changes of PCT,hs-CRP and ESR levels were consistent in patients with open fracture and closed fracture.The time from injury to operation,open fracture and≥2 operations were risk factors of postoperative infection(P<0.05),and the aseptic operation standard was a protective factor(P<0.05).The specificity and AUC values of the combined prediction of serum levels of PCT,hs-CRP and ESR were higher than those of the single prediction.Conclusion The levels of serum PCT,hs CRP and ESR are generally high after the operation of internal fixation of limb fracture,and the above indexes are higher in the patients with early postoperative fever,especially in the patients with secondary infection.The predictive effect of the combination of the three indexes is higher than that of the single detection.