血清正五聚蛋白3对坏死性软组织感染的诊断效能研究

Study on the Diagnostic Efficacy of Serum Pentraxin 3 in Necrotic Soft Tissue Infection

目的:探讨血清正五聚蛋白3(Pentraxin 3,PTX3)对坏死性软组织感染(Necrotizing soft tissue infection,NSTI)的诊断效能。方法:选取喀什地区第一人民医院2021年6月-2022年6月行急诊手术治疗的158例疑似NSTI患者作为研究对象,根据术后诊断结果将其分为NSTI组(97例)和非NSTI组(61例),另选取同期该院体检中心健康人群97例作为健康组。比较NSTI组、非NSTI组入院即刻和健康组体检时血清PTX3、C-反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)、红细胞沉降率(Erythrocyte sedimentation rate,ESR)、白细胞介素-6(Interleukin-6,IL-6)水平,绘制健康志愿者工作特征(Receiver operating characteristic,ROC)曲线分析上述指标对NSTI的诊断效能。另观察NSTI组患者入院即刻、入院第2天、第3天血清炎症指标水平变化,并统计NSTI组患者住院天数、截肢率、死亡率。另外,根据术后诊断结果将NSTI组分为坏死性筋膜炎组和气性坏疽组,比较两组不同时刻血清炎症指标水平变化,并观察各指标对坏死性筋膜炎和气性坏疽的诊断效能。结果:NSTI组、非NSTI组血清PTX3、CRP、PCT、ESR、IL-6水平均高于健康组(P<0.05),NSTI组均高于非NSTI组(P<0.05);ROC曲线分析结果显示,血清PTX3诊断NSTI的灵敏度均高于CRP、PCT、ESR、IL-6;特异度稍低于PCT,但均高于CRP、ESR、IL-6;曲线下面积(Area under the curve,AUC)均高于CRP、PCT、ESR、IL-6。气性坏疽组血清PTX3、CRP、PCT、ESR、IL-6水平均高于坏死性筋膜炎组(P<0.05);ROC曲线分析结果显示,血清PTX3诊断坏死性筋膜炎和气性坏疽的灵敏度均高于CRP、PCT、ESR、IL-6;特异度稍低于PCT,但均高于CRP、ESR、IL-6;AUC均高于CRP、PCT、ESR、IL-6。入院即刻、入院第2天、入院第3天血清PTX3、CRP、PCT、ESR、IL-6水平在组间、时间、交互效应上差异均有统计学意义(P<0.05);入院第3天血清各指标水平均低于入院即刻和入院第2天(P<0.05),且气性坏疽组入院即刻、入院第2天、入院第3天血清各指标水平均高于坏死性筋膜炎组(P<0.05);气性坏疽组住院平均天数、截肢率、死亡率均高于坏死性筋膜炎组(P<0.05)。结论:NSTI患者血清PTX3水平异常升高,且气性坏疽患者均高于坏死性筋膜炎患者,另PTX3对诊断NSTI和鉴别坏死性筋膜炎与气性坏疽的效能均优于CRP、PCT、ESR、IL-6等常规炎症指标。

Objective To investigate the diagnostic efficacy of serum serum Pentraxin 3(PTX3) in necrotic soft tissue infection(NSTI). Methods 158 suspected NSTI patients who underwent emergency surgery in Kashgar First People's Hospital from June 2021 to June 2022 were selected as the study subjects, and they were divided into NSTI group(97 cases) and non NSTI group(61 cases) according to the results of postoperative diagnosis. Another 97 healthy people from the physical examination center of the hospital were selected as the health group. The levels of serum PTX3, C-reactive protein(CRP), procalcitonin(PCT), erythrocyte sedimentation rate(ESR) and interleukin-6(IL-6) in NSTI group, non NSTI group at the time of admission and health group at the time of physical examination were compared, and the receiver operating characteristic(ROC) curve was drawn to analyze the diagnostic efficacy of the above indicators for NSTI. In addition, the changes of serum conventional inflammatory marks levels of patients in the NSTI group at the moment of admission, the second and third days of admission were observed, and the days of hospitalization, amputation rate and mortality rate of patients in the NSTI group were counted.In addition, the NSTI group was divided into necrotizing fasciitis group and gas gangrene group based on the postoperative diagnostic results, and the changes in serum conventional inflammatory marks levels between two groups at different times were compared, and the diagnostic efficacy of each indicator for necrotizing fasciitis and gas gangrene was observed. Results The levels of serum PTX3, CRP, PCT, ESR, IL-6 in NSTI group and non NSTI group were higher than those in healthy group(P<0.05), which in the NSTI group were higher than those in non NSTI group(P<0.05). ROC curve analysis showed that the sensitivity of serum PTX3 in diagnosing NSTI was higher than that of CRP, PCT, ESR and IL-6, and the specificity was slightly lower than PCT, but it was higher than CRP, ESR, IL-6, and area under the curve(AUC) was higher than CRP, PCT, ESR and IL-6. The serum PTX3, CRP, PCT, ESR, and IL-6 levels in the gas gangrene group were higher than those in the necrotizing fasciitis group(P<0.05). The ROC curve analysis results showed that the sensitivity of serum PTX3 in diagnosing necrotizing fasciitis and gas gangrene was higher than that of CRP, PCT, ESR, and IL-6, and the specificity was the same as PCT, but higher than CRP, ESR, and IL-6, and the AUC was higher than CRP, PCT, ESR and IL-6. There were statistically significant differences in serum PTX3, CRP, PCT, ESR and IL-6 levels among groups, time and interaction effects immediately after admission, on the second day of admission and on the third day of admission(P<0.05). The levels of serum indicators on the third day of admission were lower than those immediately and on the second day of admission(P<0.05), and the gas gangrene group had higher levels of serum indicators on the first day, second day, and third day of admission than the necrotizing fasciitis group(P<0.05). The average length of hospital stay, amputation rate and mortality rate in the gas gangrene group were higher than those in the necrotizing fasciitis group(P<0.05). Conclusion The serum PTX3 level in NSTI patients are abnormally elevated, and patients with gas gangrene are all higher than those with necrotizing fasciitis. In addition, PTX3 is more effective in diagnosing NSTI and distinguishing necrotizing fasciitis from gas gangrene than conventional inflammatory indicators such as CRP, PCT, ESR, IL-6.