创伤后骨髓炎患者血清中常见炎性标志物的诊断价值

Diagnostic value of common inflammatory markers in serum of patients with post-traumatic osteomyelitis

目的 对创伤后骨髓炎患者血清中常见炎性标志物降钙素原(PCT)、中性粒细胞和淋巴细胞比值(NLR)、超敏C反应蛋白(hs-CRP)、白细胞(WBC)的诊断价值进行评价。方法 回顾性分析2018年1月至2020年12月沈阳医学院附属中心医院手外一科至手外六科手外伤术后并发骨髓炎的患者30例,与同期创伤后细菌感染的患者40例及创伤后未感染的患者40例进行比较。于手术后第1天采集患者的静脉血进行PCT、hs-CRP、WBC的测定,并计算出NLR;并采集伤口分泌物进行细菌培养,连续3 d。结果 30例创伤后骨髓炎组的分泌物培养结果以金黄色葡萄球菌和铜绿假单胞菌为主,有4例为无细菌生长。40例创伤后细菌感染组的分泌物培养结果以金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌、黏质沙雷菌、大肠杆菌为主,无细菌生长者4例。创伤后未感染组40例均无细菌生长。创伤后骨髓炎组与创伤后细菌感染组比较以及创伤后细菌感染组与创伤后未感染组间PCT、hs-CRP、NLR、WBC比较,差异有统计学意义(P<0.05)。创伤后骨髓炎组与创伤后未感染组间比较,差异无统计学意义(P>0.05)。结论 PCT、hs-CRP、WBC、NLR在创伤后骨髓炎组和创伤后细菌感染组之间差异有统计学意义,PCT、hs-CRP结合分泌物细菌培养的结果可将创伤后骨髓炎、创伤后细菌感染及创伤后未感染三组区分开。

Objective To evaluate the diagnostic value of common inflammatory markers procalcitonin(PCT), granuleto-lymphocyte ratio(NLR), high-sensitivity C-reactive protein(hs-CRP) and white blood cell(WBC) in the serum of patients with post-traumatic osteomyelitis. Methods A retrospective analysis of 30 patients with osteomyelitis after hand trauma treated in the First to Sixth Department of Hand of Central Hospital Affiliated to Shenyang Medical College from January 2018 to December 2020 was conducted. A total of 40 patients with post-traumatic bacterial infection and a total of 40 post-traumatic uninfected patients were selected. On the first day after surgery, the venous blood was collected for the determination of PCT, hs-CRP, and WBC, and NLR was calculated. The wound secretions were collected for bacterial culture for 3 consecutive days. Results The secretion culture results of the 30 patients in the post-traumatic osteomyelitis group were mainly Staphylococcus aureus and Pseudomonas aeruginosa, and 4 patients showed no bacterial growth. The secretion culture results of the 40 patients in the post-traumatic bacterial infection group were mainly Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, Serratia marcescens, and Escherichia coli, and 4 patients showed no bacterial growth. There was no bacterial growth in the 40 patients in the post-traumatic uninfected group. There were significant differences in PCT, hs-CRP, NLR, WBC levels between the post-traumatic osteomyelitis group and the post-traumatic bacterial infection group, and between the post-traumatic bacterial infection group and post-traumatic uninfected group(P<0.05). There were no significant differences in PCT,hs-CRP, NLR, WBC levels between the post-traumatic osteomyelitis group and the post-traumatic uninfected group(P>0.05). Conclusion PCT, hs-CRP, WBC, and NLR are significantly different between the post-traumatic osteomyelitis group and the post-traumatic bacterial infection group. PCT and hs-CRP combined with secretion bacterial culture result can distinguish the post-traumatic osteomyelitis group, the post-traumatic bacterial infection group, and the post-traumatic uninfected group.