血清C反应蛋白和红细胞沉降率在关节假体周围感染患者中表达及不符合MSIS诊断标准的相关因素

Expression of serum C-reactive protein and erythrocyte sedimentation rate in patients with periprosthetic infection and related factors not meeting MSIS diagnostic criteria

目的分析关节假体周围感染患者血清C反应蛋白以及红细胞沉降率表达情况不符合美国肌肉骨骼感染协会(American Musculoskeletal Infection Association,MSIS)诊断标准的有关因素。方法选取2017年3月至2020年3月在菏泽市立医院因关节假体周围感染而进行住院治疗的50例患者作为研究对象。全部患者均在使用抗生素治疗前或手术治疗前进行血清红细胞沉降率以及血清C反应蛋白检查,按照MSIS诊断标准对关节假体周围感染进行诊断。依患者血清C反应蛋白以及红细胞沉降率水平是否符合MSIS诊断标准将其分成符合组以及不符合组,Logistic回归分析两组患者关节假体周围感染血清学指标不符合MSIS诊断标准的影响因素。结果血清红细胞沉降率以及C反应蛋白水平符合MSIS诊断标准者共32例(64.00%)、不符合MSIS诊断标准者18例(36.00%)。两组患者细菌培养结果以及免疫状态差异均具统计学意义(χ^(2)分别为4.217、7.797,P值均<0.05),病原体类型无明显差异(χ^(2)=2.097,P>0.05)。两组患者常见病原菌不同免疫状态分级比较无明显差异(χ^(2)分别为1.821、0.613,P值均>0.05)。Logistic回归表明细菌培养结果呈阳性以及免疫B级是导致患者实验室指标不符合MSIS诊断标准的影响因素(OR值分别为0.466、0.580,P值均<0.05)。结论细菌培养结果呈阴性以及免疫状态良好的关节假体周围感染患者血清C反应蛋白以及红细胞沉降率不符合MSIS诊断标准的发生率相对较高,在进行疾病诊断时需要对患者实验室指标实施全面分析,减少漏诊。

Objective To analyze the related factors of serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)expression in patients with periprosthetic infection that did not meet the diagnostic criteria of American musculoskeletal infection Association(MSIS).Methods Fifty patients with periprosthetic infection in Heze City Hospital were selected as research samples from March 2017 to March 2020.Serum erythrocyte sedimentation rate and serum C-reactive protein were detected before antibiotic treatment or surgical treatment.MSIS was used to diagnose periprosthetic infection.According to whether the levels of serum C-reactive protein and erythrocyte sedimentation rate meet the MSIS diagnostic criteria,they were divided into the compliance group and the non-compliance group.Logistic regression equation for analysis to explore the influencing factors of serological indexes in patients with periprosthetic infection that do not meet the diagnostic criteria.Results A total of 32 cases(64.00%)met the diagnostic criteria of MSIS,18 cases(36.00%)did not meet the diagnostic criteria of MSIS.In terms of bacterial culture results and immune status grading,there were significant differences between the two groups(χ^(2) values were 4.217 and 7.797,respectively,both P values<0.05).There was no significant difference in pathogen types between the two groups(χ^(2)=2.097,P>0.05).There was no significant difference in the immune status of common pathogens between the two groups(χ^(2) values were 1.821 and 0.613,respectively,both P>0.05).The results showed that the positive results of bacterial culture and immune grade B were the influencing factors of laboratory indexes not meeting the MSIS diagnostic criteria(OR values were 0.466 and 0.580,respectively,both P<0.05).Conclusion Patients with a negative bacterial culture result as well as a good immune status who have a periprosthetic joint infection have a relatively high incidence of serum C-reactive protein as well as erythrocyte sedimentation rate not meeting the MSIS diagnostic criteria.Therefore,it is necessary to conduct a comprehensive analysis of other indicators of patients in order to reduce missed diagnosis.