腰椎术后联合检测C反应蛋白、红细胞沉降率及降钙素原对术后早期感染诊断的临床意义

马风华， 田征， 宋兴华， 王翀

(新疆医科大学第一附属医院骨科中心， 乌鲁木齐830054)

摘要：目的探讨腰椎术后联合检测C反应蛋白(CRP)、红细胞沉降率(ESR)及降钙素原(PCT)对不同术式术后早期感染诊断的临床意义。方法选取不同术式腰椎术后正常愈合患者(非感染组，297例)及发生术后感染患者(感染组，31例)。比较两组患者术前及术后第1、3、5、7天血清CRP、ESR及PCT水平变化。 结果不同术式感染组及非感染组患者术后CRP、ESR及PCT水平均较术前偏高；两组放置内固定患者术后CRP及ESR峰值均高于无内固定患者；行相同术式的患者，感染组术后CRP、ESR及PCT水平均较非感染组偏高，差异均有统计学意义(P<0.05)。以术后第3天患者CRP>25 mg/L(内固定患者CRP>46 mg/L)、术后第5天ESR>45 mm/h、PCT>2.0 μg/L作为诊断标准，任一指标超过界值则诊断感染，3 项指标均未达到界值则排除感染，则对于术后早期感染诊断的灵敏度为99%，特异度为98%。结论腰椎术后动态联合监测血浆CPR、ESR及PCT水平对术后早期感染诊断意义较大，且出现术后第3天CRP>25 mg/L(放置内固定患者CRP>46 mg/L)、术后第5天ESR>45 mm/h及PCT>2.0 μg/L时应积极预防术后早期感染。

关键词：C反应蛋白； 血沉； 降钙素原； 腰椎； 术后感染； 诊断

中图分类号：R619.3文献标识码：A

doi:10.3969/j.issn.1009-5551.2015.05.021

[收稿日期：2014-12-16]

基金项目：新疆维吾尔自治区人民医院科研项目(2010103)

作者简介：付娟娟(1980-)女，硕士，主治医师，研究方向：临床病理学，E-mail：juanjuan805@163.com。

基金项目：新疆医科大学科研创新基金(XJC201275)

作者简介：毕兴(1981-)，男，硕士，讲师，研究方向：泌尿系肿瘤。

The clinical significance of combined detection of C-reactive protein,

erythrocyte sedimentation rate and procalcitonin in diagnosing early

postoperative infection after lumbar operation

MA Fenghua， TIAN Zheng， SONG Xinghua， WANG Chong

(DepartmentofOrthopedicCenter,TheFirstAffiliatedHospitalofXinjiangMedicalUniversity,

Urumqi830054,China)

Abstract：ObjectiveTo explore the clinical significance of combined detecting serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and procalcitonin (PCT) regular level in the early diagnosis of infection after lumbar operation by different operating methods. Methods297 cases of normal healed patients (uninfected group) and 31 cases of patients (infected group) with early postoperative infection after lumbar operation were selected. The level of CRP, ESR, PCT in patients′ serum before operation and after 1, 3, 5, 7 days of operation were compared between two groups. ResultsThe postoperative ESR, CRP, PCT level in both groups is higher than that of pre-operation. The patients in both groups who accepted orthopaedic insertion have a higher peak of ESR, CRP, PCT than patients without insertion. The ESR, CRP and PCT level in infected group of patients who accepted the same operation is higher than uninfected patients. All of these differences were statistically significant (P<0.05). With the CRP>25 mg/L (CRP>46 mg/L patients who have internal fixation) at postoperative day 3 in patients, ESR>45 mm/h, PCT>2.0 μg/L at postoperative day 5 as diagnostic standard, any index exceeds its critical value can be diagnosed as infection. Infection would be ruled out if three indicators did not reach the critical value. The sensitivity for diagnosis of early infection in patients after lumbar operation was 99%, and the specificity was 98%. ConclusionCombined detection of CPR, ESR and PCT regular level in serum has a high significance in the early diagnosis of infection after lumbar operation. And the early postoperative infection should be prevented when the level of CRP is higher than 25 mg/L (patients with insertion CRP>46 mg/L) after 3 days after surgery, and the level of ESR is higher than 45 mm/h, PCT>2.0 μg/L after 5 days after surgery.

Key words： CRP; ESR; PCT; lumbar; postoperative infection; diagnosis

脊椎术后感染仍是一项术后较严重的并发症，发生率为0.4% ~3.5%[1]。后期非手术治疗或手术治疗……