血清SDF-1、sCD14-ST、TLR-4在骨关节置换术后感染中的表达及预测价值

Expression and predictive value of serum SDF-1,sCD14-ST and TLR-4 in infection after bone and joint replacement

目的探究血清基质细胞衍生因子-1(SDF-1)、可溶性白细胞分化抗原14亚型(sCD14-ST)、Toll样受体4(TLR-4)水平在骨关节置换术后感染中的表达及预测价值.方法选取福建中医药大学附属康复医院及福建医科大学附属福州市第一医院2021年3月—2023年3月收治的骨关节置换术后感染患者61例作为感染组,另选同期骨关节置换术后未感染患者61例作为非感染组;通过Logistic回归分析法分析骨关节置换术患者术后感染发生的危险因素,比较非感染组和感染组血清中SDF-1、sCD14-ST、TLR-4水平,采用受试者工作特征(ROC)曲线分析血清SDF-1、sCD14-ST、TLR-4水平单一及联合检测对骨关节置换术患者术后感染的诊断价值.结果Logistic分析结果显示,年龄、长期使用激素类药物、合并糖尿病、手术时间、术后引流时间、白蛋白≤35g/L是骨关节置换术患者术后感染发生的危险因素(P<0.05);感染组血清SDF-1、sCD14-ST、TLR-4表达水平均高于非感染组(P<0.05);血清SDF-1、sCD14-ST、TLR-4表达水平联合检测诊断骨关节置换术患者术后感染的AUC值比单一检测值高(P<0.05),且联合检测的敏感度、特异度为90.16%、75.41%.结论骨关节置换术患者术后感染与年龄、长期使用激素类药物、合并糖尿病、手术时间、术后引流时间、白蛋白水平有关,血清SDF-1、sCD14-ST、TLR-4水平在骨关节置换术患者术后感染呈高表达,且三者联合检测可提高对感染的诊断价值.

OBJECTIVE To investigate the expression and predictive value of serum stromal cell-derived factor-1(SDF-1),soluble leukocyte differentiation antigen 14 subtype(sCD14-ST)and Toll-like receptor 4(TLR-4)lev-els in patients with infection after bone and joint replacement.METHODS A total of 61 patients with infection after bone and joint replacement admitted to the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine and Fuzhou First Hospital Affiliated to Fujian Medical University from Mar 2021 to Mar 2023 were selected as the infection group,and 61 patients without infection after bone and joint replacement during the same period were selected as the non-infection group.The risk factors of postoperative infection in patients with bone and joint replacement were analyzed by logistic regression analysis,and the serum levels of SDF-1,sCD14-ST and TLR-4 between the non-infected group and the infected group were compared.Receiver operating charac-teristic(ROC)curve was used to analyze the diagnostic value of serum SDF-1,sCD14-ST and TLR-4 levels in pa-tients with postoperative infection after bone and joint replacement.RESULTS Logistic analysis showed that age,long-term use of hormone drugs,complicated diabetes mellitus,operation time,postoperative drainage time,al-bumin≤35 g/L were the risk factors for postoperative infection in patients with bone and joint replacement(P<0.05).The expression levels of serum SDF-1,sCD14-ST and TLR-4 in the infected group were higher than those in the non-infected group(P<0.05).The AUC value of combined detection of serum SDF-1,sCD14-ST,and TLR-4 expression levels in the diagnosis of postoperative infection in patients undergoing bone joint replacement was higher than that of single detection(P<0.05),and the sensitivity and specificity of combined detection were 90.16%and 75.41%,respectively.CONCLUSION Postoperative infection in patients with bone and joint replacement is related to age,long-term use of hormone drugs,diabetes mellitus,operation time,postoperative drainage time and albu-min level.Serum SDF-1,sCD14-ST and TLR-4 levels are highly expressed in postoperative infection in patients with bone and joint replacement,and the combined detection of these three indexes can improve the value in diagnosis of infection.