摘要
目的：评价腰椎内固定术后发热患者血清PCT、CRP、ESR水平，以及WBC计数在诊断患者是否合并感染中的作用。方法：对2012年1月至2014年1月间在脊柱外科接受腰椎后路内固定术治疗并在术后早期（术后10d内）出现发热症状的58例患者进行回顾性分析。根据细菌学培养结果将58例患者分为发热并感染组（A组）和发热非感染组（B组），其中A组26例，B组32例。收集临床数据，比较两组间血清PCT、CRP、ESR，以及WBC计数的差异。根据受试者工作特征（ROC）曲线，分析上述指标在诊断术后早期发热患者是否合并感染中的作用。结果：A组PCT、CRP、ESR高于B组（P〈0．05），但是B组CRP、ESR仍高于正常范围。同时在A组中，PCT在鉴别感染类型方面要优于CRP和ESR。各指标ROC曲线分析示，PCT曲线下面积最大，CI95％为0．81-0．98，WBC计数对应的ROC则差异无统计学意义。对应各指标的截断点，CRP特异度最高为90．27％，ESR的灵敏度最高为88．50％。结论：对于腰椎后路内固定术后早期发热患者应予以足够的重视，合理选取监测指标对于早期诊断、早期预防感染有良好的参考价值。其中PCT受手术影响较小，在鉴别感染类型方面有一定的参考价值，CRP和ESR可作为初筛检测指标，WBC计数意义有限。
Objective ： To evaluate the role of serum level of procalcitonin （PCT）, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, and white blood cell count （WBC） as predictors in postoperative early infectious complications with fever after posterior lumbar internal fixation （PLIF）. Methods ：A retrospective study was conducted from January 2012 to January 2014. Fifty-two patients with fever in the early stage （within 10 days） after the PLIF were collected in the study. They were divided into infection group and non-infection group （group A and group B ） according to the results of postoperative blood culture. There were 26 patients in group A and 32 patients in group B. The values of PCT,CRP,ESR,and WBC count were compared and analyzed between two groups. Results：The values of PCT, CRP, and ESR in group A were higher than those of group B. Meanwhile, CRP and ESR in group B were still higher than the normal range. Among the 26 patients with infections （group A）, PCT was superior to CRP and ESR, had a good ability in discriminating different kinds of postoperative infections. The area under the ROC curve of serum PCT levels was the largest （CI 95% was 0.81 to 0.98） in the indexs;and ROC curve of WBC count was no statistically significant. When the cut off points of each predictors were evaluated,the higher sensitive was CRP and reached at 90.27% and the higher specific was ESR and reached at 88.50%. Conclusion： For the patients with fever at the early stage after the PLIF should be paid attention and reasonable choosing predictors are helpful to identify postoperative infection in the early stage. The CRP and ESR may be influenced by the surgery,and the PCT level is helpful to differentiate infection type.
出处
《中国骨伤》
CAS
2015年第1期66-70,共5页
China Journal of Orthopaedics and Traumatology
关键词
降钙素
血细胞计数
白
C反应蛋白质
血沉
腰椎后路内固定术
Calcitonin
Blood cell count,white
C-reactive protein
Blood sedimentation
Posterior lumbar internal fixation
