血清PCT、hs-CRP联合ESR在四肢骨折内固定术后早期发热患者继发感染中的预测价值

目的 分析血清降钙素原(PCT)、高敏-C反应蛋白(hs-CRP)联合红细胞沉降率(ESR)在四肢骨折内固定术后早期发热患者继发感染中的预测价值.方法 回顾性分析2017年1月—2020年10月连云港市第二人民医院急诊外科收治的198例四肢骨折内固定术后患者(骨折术后组)和182例同年龄段健康志愿者(健康志愿组)资料.骨折术后组男性104例,女性94例;年龄20～78岁,平均52.5岁;道路交通伤101例,高处坠落伤46例,跌倒伤30例,殴打伤21例.健康志愿组男性98例,女性84例;年龄20～78岁,平均51.5岁.骨折术后组于术后48h抽取外周静脉血,健康志愿组采用体检剩余外周静脉血.分别采用酶联荧光法、全程C反应蛋白定量测试剂盒、全自动血沉仪检测血清PCT、hs-CRP及ESR水平,并比较两组差异.比较骨折术后组开放骨折、闭合骨折术后早期发热与未发热患者、术后早期发热患者中继发感染和未继发感染患者的血清PCT、hs-CRP及ESR水平,分析术后感染的影响因素,以及血清PCT、hs-CRP、ESR水平联合预测骨折术后组术后早期发热患者继发感染的灵敏度、特异度、曲线下面积(AUC).结果 骨折术后组中术后早期发热者占比38.9％(77/198),其中继发感染者占比38％(29/77),术后感染率为14.6％(29/198);骨折术后组术后血清PCT、hs-CRP及ESR水平均高于健康志愿组[(3.52±0.75)μg/L vs.(0.48±0.08)μg/L,(10.69±2.15)mg/L vs.(2.10±0.41)mg/L,(26.41±4.55)mm/h vs.(10.52±2.12)mm/h],骨折术后组中术后早期发热患者血清PCT、hs-CRP及ESR水平均高于未发热患者[(5.97±1.69)μg/L vs.(1.96±0.37)μg/L,(19.25±3.35)mg/L vs.(5.24±1.03)mg/L,(42.95±7.83)mm/h vs.(15.88±3.12)mm/h],术后早期发热患者中继发感染者血清PCT、hs-CRP及ESR水平均高于未感染者[(6.25±1.72)μg/L vs.(2.04±0.39)μg/L,(21.30±3.40)mg/L vs.(5.65±1.09)mg/L,(70.25±9.41)mm/h vs.(26.46±5.02)mm/h],差异均有统计学意义(P＜0.05).开放性骨折、闭合性骨折患者中上述指标变化趋势均一致;受伤至手术时间、开放性骨折、≥2次手术均为术后感染的危险因素(P＜0.05),按无菌术标准执行是其保护因素(P＜0.05);血清PCT、hs-CRP及ESR水平联合预测四肢骨折内固定术后早期发热患者继发感染的特异度、AUC均高于单独预测.结论 四肢骨折内固定术后血清PCT、hs-CRP及ESR水平普遍偏高,术后早期发热患者上述指标水平更高,尤其是继发感染患者,三者联合对此类患者继发感染的预测效能高于单独检测.     

C反应蛋白用于监测骨折术后感染的意义

目的对92例下颌骨骨折住院病例作C-反应蛋白监测,旨在早期发现骨折术后感染。方法入院时和住院期间每日检查C-反应蛋白水平。结果术前C-反应蛋白均值28.5 mg/L,术后所有病例均有C-反应蛋白水平增高,术后第2天达到最高值(均值73.2 mg/L),创伤后骨折手术时间显著影响术后C-反应蛋白水平,内固定方法中微型接骨板对C-反应蛋白水平影响最小。结论由于血清CRP的灵敏度高,在下颌骨骨折患者术后合并感染时,有助于临床早期的鉴别诊断。     

血清NLR、TLR2、CRP/ALB水平与股骨颈骨折术后感染相关性及临床预测价值分析

目的 研究中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte Ratio,NLR)、Toll样受体-2(TLR2)及C反应蛋白/白蛋白(CRP/ALB)水平与股骨颈骨折术后感染的相关性,并分析其在预测股骨颈骨折术后感染中的临床价值。 方法 选取内蒙古医科大学第二附属医院2018.06-2021.06股骨颈骨折手术279例,根据术后感染情况分为感染组（n=30）和非感染组（n=249）,同期60例健康体检合格者纳为对照组,分别在股骨颈骨折患者术后d1及对照组入组后,采集被研究者外周静脉血,电阻法检测NLR水平,酶联免疫吸附法检测TLR2以及CRP/ALB水平。分别比较各组NLR、TLR2以及CRP/ALB水平。先后行单因素及多因素Logistic回归分析,分析影响股骨颈骨折术后感染的独立危险因素。绘制受试者工作特征曲线(ROC),分析术后1 d NLR、TLR2、CRP/ALB水平在预测骨折术后感染中的价值。 结果 股骨颈骨折患者术后1 d NLR、TLR2、CRP/ALB水平均高于对照组,差异均具有统计学意义（P<0.001）。感染组术后d1 NLR、TLR2、CRP/ALB水平均高于非感染组,差异均具有统计学意义（P<0.05）。多因素回归分析发现,术前贫血、围术期异体输血、手术时间以及术后1 d NLR、TLR2以及CRP/ALB水平是影响股骨颈骨折术后感染的独立因素。绘制ROC曲线发现,术后1 d NLR、TLR2、CRP/ALB单独应用,在预测股骨颈骨折术后感染中,以CRP/ALB最高,其AUC=0.888,95%CI为(0.811~0.964),三指标联合应用则可提高各指标单独应用时效能,其AUC=0.900,95%CI为(0.825~0.975)。 结论 股骨颈骨折术后1 d 外周血NLR、TLR2、CRP/ALB水平异常升高是股骨颈骨折患者术后手术部位感染的独立危险因素,并在预测股骨颈骨折术后感染中具有一定的价值。     

炎性指标诊断发热待查感染性疾病的价值

 目的 探讨炎性指标在确诊感染性疾病的发热待查(fever of unknown origin,FUO)患者中的变化,为鉴别感染性疾病提供帮助。方法 选取2016-01至2018-01首都医科大学宣武医院以FUO入院,确诊感染性疾病的患者,包括病毒感染、细菌感染(结核感染、布氏杆菌病、细菌性心内膜炎、肺部感染及泌尿系感染等)和真菌感染患者。临床观察指标包括:患者的一般状况、发热持续时间,以及患者入院首次检测的外周血白细胞(WBC)、红细胞沉降率(ESR)、C-反应蛋白(CRP)及降钙素原(PCT)等指标水平。结果 共收集FUO患者300例,其中确诊感染性疾病患者64例(21.3%)。64例中,病毒感染13例,细菌感染39例(结核感染11例,布氏杆菌病6例,细菌性心内膜炎12例,肺部或泌尿道感染10例),真菌感染12例。ESR水平在细菌感染[(62.6±33.3)mm/h]与真菌感染[(26.6±32.0)mm/h]患者中差异有统计学意义(P=0.034);CRP在病毒感染[(32.1±31.7)mg/L]与细菌感染[(54.8±43.0)mg/L]、细菌感染[(54.8±43.0)mg/L]与真菌感染[(17.2±20.2)mg/L]患者中差异均具有统计学意义(P=0.03);WBC和PCT水平在病毒感染、细菌感染及真菌感染患者间差异无统计学意义。而在不同细菌感染疾病患者中,WBC、ESR、CRP及PCT等均无统计学差异。通过ROC曲线计算,CRP在鉴别细菌感染与病毒感染灵敏度为77.1%,阈值为84.5mg/L;ESR在鉴别细菌感染及真菌的灵敏度为84.4%,阈值为45 mm/h。结论 CRP与ESR水平在FUO患者鉴别不同感染具有一定临床意义,WBC水平意义不大,PCT水平需谨慎解读。     

烧伤脓毒症患者外周C-反应蛋白和CD64水平动态变化

 目的 探讨早期烧伤脓毒症患者外周C-反应蛋白(C- reactive protein,CRP)和CD64水平动态变化。方法 选择我院烧伤科2013-01至2014-01收治的80例烧伤患者,根据是否诊断烧伤脓毒症分为两组,烧伤脓毒症组40例和对照组40例。两组患者入院后及时给予抗生素抗感染治疗,补液抗休克治疗,创面积极换药,保持水电解质平衡等对症支持治疗。对比烧伤脓毒症组和对照组中性粒细胞CD64及CRP水平以及不同烧伤面积患者中性粒细胞CD64及CRP水平。结果 烧伤脓毒症组和对照组中性粒细胞CD64分别为(65.2±18.6)%、(16.8±5.7)%, 两组CRP水平为(157±34.8)mg/L、(19.6±2.2)mg/L,差异均有统计学意义(P<0.05);烧伤脓毒症组患者(烧伤面积小于60%)和烧伤脓毒症组患者(烧伤面积大于60%)中性粒细胞CD64及CRP水平分别为(46.8±13.5)%、(135.7±32.8)mg/L;(76.9±24.3)%,(189.6±40.5)mg/L,对比差异有统计学意义(t=8.6、7.9,P<0.05)。在烧伤脓毒症时,中性粒细胞CD64的ROC曲线下面积(AUC)最大,优于CRP(P<0.05)。采用约登指数(正确指数=灵敏度+特异度-1)最大值所对应值,得出有意义指标的最佳截断点(cut-off point),得出对CD64、CRP对诊断烧伤脓毒症的灵敏度、特异度、阳性预测值、阴性预测值,结果显示CD64灵敏度、特异度、阳性预测值、阴性预测值均高于CRP(P<0.05)。结论 在烧伤伴脓毒症的细菌感染中,CD64具有较高的特异性,其灵敏度、特异度、阳性预测值、阴性预测值均高于CRP。     

术前血清白蛋白水平对老年股骨颈骨折髋关节置换术后切口感染的预测价值分析

目的 探讨术前血清白蛋白水平对老年股骨颈骨折患者髋关节置换术后切口感染的预测价值。方法 选取2021年6月至2022年6月河南大学第一附属医院收治的96例行人工髋关节置换术治疗的老年股骨颈骨折患者作为研究对象,收集患者性别、年龄、麻醉方式、手术方式、是否合并糖尿病、是否合并高血压、是否长期使用抗凝药物、术前血清白蛋白水平等资料,根据髋关节置换术后1周切口是否发生感染将患者分为感染组与未感染组,分析术前血清白蛋白水平对老年股骨颈骨折髋关节置换术后切口感染的预测价值。结果 96例老年股骨颈骨折患者髋关节置换术后1周发生切口感染7例(7.29%),设为感染组;未发生切口感染89例(92.71%),设为未感染组。点二列相关性分析结果显示,术前血清白蛋白水平与老年股骨颈骨折髋关节置换术后切口感染呈显著负相关性(r=-0.247,P=0.015);受试者工作特征(ROC)曲线分析结果显示,术前血清白蛋白水平预测老年股骨颈骨折髋关节置换术后切口感染的曲线下面积(AUC)为0.773,特异度为71.4%,敏感度为75.3%。结论 术前血清白蛋白水平可作为临床预测老年股骨颈骨折患者髋关节置换术后切口感染...     

CRP/Alb比值对老年髋部骨折患者术后1年内死亡的预测价值分析

目的 探讨血清C反应蛋白与白蛋白比值(CRP/Alb)对老年髋部骨折患者术后1年内死亡的预测价值.方法 回顾性分析2018年6月—2019年6月无锡市人民医院骨科收治的154例老年髋部骨折患者的病例资料,男性103例,女性51例;年龄65～85岁,平均75.8岁;合并0～2种内科疾病106例,2种以上48例.根据患者术后1年内生存情况分为存活组(121例)与死亡组(33例),收集可能影响患者生存的相关影响因素,包括性别、年龄、体质量指数(BMI)、合并疾病、血常规、肝肾功能、手术方式、麻醉方式、手术时长、致伤原因等,同时记录患者入院当天、术后第1天、第3天CRP、Alb以及CRP/Alb的平均值,运用二分类多因素Logistic回归分析.结果 术后1年内随访率为100％.其中154例患者死亡33例,病死率为21.43％.单因素结果显示,老年髋部骨折患者术后1年内死亡,与年龄>75岁、合并多种内科疾病、白蛋白(Alb)水平低、C反应蛋白(CRP)水平高、CRP/Alb比值高以及美国麻醉医师协会(ASA)分级III～IV级有关(t=30.256、56.411、4.007、20.644、6.509、16.684,P<0.05);多因素结果显示,Alb水平低、CRP水平高、CRP/Alb比值低是老年髋部骨折患者术后1年内死亡的独立危险因素(OR=1.532、2.114、2.625,P<0.05);CRP/Alb预测老年髋部骨折患者术后预后不良的曲线下面积(area under ROC curve,AUC)均明显高于CRP或Alb单指标预测(P<0.05).结论 老年髋部骨折患者术后1年内死亡与CRP/Alb比值增大有关,是患者术后1年内死亡的相关因素,CRP/Alb比值可作为临床预测患者不良结局的重要指标.     

胫骨平台骨折微创锁定钢板内固定术后深静脉血栓发生的相关危险因素分析

目的 探讨创伤性胫骨平台骨折微创锁定钢板内固定(MIPPO)术后深静脉血栓发生的相关危险因素.方法 回顾性分析2017年1月—2020年2月广东省惠州市惠东县人民医院手术治疗创伤性胫骨平台骨折患者239例,男性156例,女性83例;年龄55～65岁,平均60.0岁.依据患者意愿决定手术方式,行关节镜辅助下MIPPO 192例,行传统切开复位钢板内固定术47例,依据超声等综合诊断结果分为术后下肢深静脉血栓发生组(DVT组,45例)和未发生组(无DVT组,147例).应用单因素分析比较两组患者性别、年龄、疾病史、手术情况等临床资料及术前、术后血浆D-二聚体(D-D)与纤维蛋白单体(FM)水平,以及以MIPPO术后是否发生下肢深静脉血栓为因变量,对两组患者统计学有差异的单因素进行Logistic多因素分析,并应用ROC曲线分析术后D-D与FM水平对MIPPO术后发生下肢深静脉血栓的预测价值.结果 术后随访14d.192例行MIPPO患者中45例(23.44％)术后发生下肢深静脉血栓,47例行传统切开复位钢板内固定术患者中16例(34.04％)术后发生下肢深静脉血栓,两组发生率比较差异无统计学意义(χ2=2.234,P=0.135).单因素分析结果显示,年龄、高处坠落伤、吸烟史、糖尿病、冠心病、BMI、术前及术后D-D、术前及术后FM 10个方面差异有统计学意义(P<0.05),可能是MIPPO术后发生下肢深静脉血栓的危险因素;对该10个方面单因素Logistic回归分析结果显示,年龄(OR=4.121,95％CI 1.874～9.060)、高处坠落伤(OR=5.977,95％CI 1.101～32.443)、吸烟史(OR=7.838,95％CI 1.141～53.822)、冠心病(OR=12.756,95％CI 1.800～90.382)、术后D-D(OR=8.037,95％CI 2.297～28.119)、术后FM(OR=2.815,95％CI 1.843～4.299)是MIPPO术后发生下肢深静脉血栓的独立危险因素;对术后D-D与FM水平进行ROC曲线分析,结果显示术后D-D水平ROC曲线下面积为0.746,95％的置信区间为0.682～0.810,术后D-D>9.83 mg/L是预测MIPPO术后发生下肢深静脉血栓的最佳切点,灵敏度为89.54％,特异度为63.92％;术后FM水平ROC曲线下面积为0.797,95％的置信区间为0.737～0.858,术后FM>17.58mg/L是预测MIPPO术后发生下肢深静脉血栓的最佳切点,灵敏度为85.74％,特异度为71.28％.结论 与传统切开复位钢板内固定术比较,创伤性胫骨平台骨折MIPPO术后深静脉血栓发生率没有变化,年龄、高处坠落伤、吸烟史、冠心病、术后D-D及FM是MIPPO术后发生下肢深静脉血栓的独立危险因素,且术后D-D及FM可用于预测发生下肢深静脉血栓的风险,对临床提前干预高危患者具有指导意义.     

胫骨下1/3螺旋骨折合并后踝隐匿性骨折的影像分析

目的 分析、评价X线、MSCT、MRI对胫骨下1/3螺旋骨折合并后踝隐匿性骨折的诊断价值.方法 对151例胫骨下1/3螺旋骨折进行了X线检查,未发现后踝骨折的患者行MSCT及MR检查.MSCT与MRI对于后踝骨小梁骨折和骨皮质骨折的显示能力比较采用二项分布检验.结果 151例胫骨下1/3螺旋骨折患者中有126例(83.4％)发现合并后踝骨折,其中X线检出27例(21.4％).124例行MSCT和MR检查,MRI检出后踝隐匿性骨折有99例,其中MSCT检出81例.MRI诊断后踝隐匿性骨折的敏感度、特异度、准确度分别为100％ (99/99)、100％ (25/25)、100％(124/124),MSCT分别为81.8％ (81/99)、100％( 25/25)、85.5％ (106/124).MRI对后踝隐匿性骨折的诊断准确度高于MSCT(Z=2.56,P=0.01).MSCT和MRI检出的99例后踝隐匿性骨折中,MSCT检出骨折累及骨皮质78例,MRI检出51例,MSCT诊断后踝隐匿性骨折累及骨皮质的敏感度、特异度、准确度分别为100％( 78/78)、100％ (21/21)、100％( 99/99),MRI分别为65.4％ (51/78)、100％ (21/21)、72.7％(72/99),MSCT对后踝隐匿性骨折累及骨皮质的诊断准确度高于MRI(Z=4.02,P=0.00).结论 MRI对胫骨下1/3螺旋骨折合并后踝隐匿性骨折的诊断准确度高于MSCT,MSCT对后踝隐匿性骨折累及骨皮质的诊断准确度高于MRI.     

外周血miR-223、血清胆碱酯酶、C反应蛋白对腰椎骨折内固定术后细菌感染诊断价值

目的 探讨外周血miR-223、血清胆碱酯酶(ChE)、C反应蛋白(CRP)水平对腰椎骨折内固定术后细菌感染的诊断价值。方法 选取自2019年10月至2020年10月北京积水潭医院收治的35例腰椎内固定术后感染患者为研究对象,并将其纳入B组。选取同期行腰椎骨折内固定术后未发生感染的35例患者纳入A组。术后3 d采集两组患者空腹静脉血,检测血清miR-223、ChE和CRP水平。应用受试者工作特征(ROC)曲线下面积(AUC)评价血清miR-223、ChE和CRP预测术后感染的效能。结果 B组共培养分离病原菌42株,其中革兰阳性菌31株(73.81%),革兰阴性菌11株(26.19%)。B组患者术后3 d外周血miR-223、CRP水平均高于A组,ChE水平低于A组,两组比较,差异均有统计学意义(P<0.05)。miR-223、ChE、CRP三者联合预测术后感染的AUC分别大于miR-223、ChE和CRP单独预测术后感染的AUC(Z=2.887、3.779、3.598,P<0.05)。miR-223、ChE、CRP三者联合诊断预测术后感染的特异度、准确度均高于miR-223...     

血清降钙素原对多发性骨折术后感染的诊断价值

目的探讨血清降钙素原（PCT）对多发性骨折术后感染早期的诊断价值。方法采集2011年3月～2012年3月沈阳市骨科医院骨科和重症监护病房（ICU）接诊的多发性骨折并发术后感染的50例患者的血清和术后未发生感染的50例患者的血清。采用全自动免疫荧光分析法检测血清PCT水平。结果感染组血清PCT水平高于非感染组,有显著性差异（P〈0.01）。血清PCT检测对细菌性感染的敏感性为96.5%,特异性为95.5%,阳性预测值为96.0%,阴性预测值为98.0%。PCT的ROC曲线下面积为0.972。结论血清PCT的检测有助于多发性骨折术后感染的早期诊断及鉴别诊断,并可作为判断预后的指标。     

FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis

Purpose

Antibiotic therapy in patients affected by discitis is often empirical. Therefore, early evaluation of response to therapy is important. In many patients inflammatory indexes are low during all the phases of the diseases or are altered by concomitant diseases. The aim of the study was to assess the possible role of FDG PET/CT for the early evaluation of response to therapy in patients affected by infective discitis, in comparison to C-reactive protein (CRP) serum levels.

Methods

Enrolled in the study were 38 patients diagnosed with haematogenous infective discitis. Of the 38 patients, 7 had tubercular infection, 1 fungal infection and 30 pyogenic discitis. Four patients were excluded because the second PET/CT scan was not performed. Thus 34 patients (18 women, mean age 64?years) were analysed. All the patients included underwent a FDG PET/CT scan and determination of CRP level at baseline and again 2 to 4?weeks after the start of therapy. The PET results in terms of SUV of the first and second scans (SUV1 and SUV2) and delta-SUVmax were compared to the inflammatory indexes and clinical status during therapy.

Results

The mean SUVmax at diagnosis was 8.6?±?3.7. The mean CRP level at diagnosis was 3.8?±?3.8?mg/dl. A progressive clinical response was seen in 26 patients and 8 patients showed no response. SUV1 was not correlated with the baseline CRP level (CRP1, p?=?0.7) and SUV2 was not correlated with the CRP level at the time of the second scan (CRP2, p?=?0.4). In responders, SUV2 and CRP2 were significantly lower than SUV1 and CRP1 (p?<?0.0001 and p?=?0.001, respectively). ROC curves for delta-SUVmax showed a sensitivity of 82?% and a specificity of 82?% with a cut-off of 34?%. ROC curves for SUV2 showed a sensitivity of 83?% and a specificity of 46?% with a cut-off of 6.4. ROC curves for delta-CRP showed a sensitivity of 67?% and a specificity of 89?% with a cut-off of 74?%. ROC curves for CRP2 showed a sensitivity of 65?% and a specificity of 70?% with a cut-off of 0.7?mg/dl. No statistically significant difference was found between delta-SUVmax AUC and delta-CRP AUC (p?=?0.5).

Conclusion

Delta-SUVmax provided a higher sensitivity and specificity for identifying responders. SUV2 provided comparable sensitivity, but significantly lower specificity. CRP level performed less well for identifying responders. There was no significant difference in the global performance of the two tests (delta-SUVmax AUC and delta-CRP AUC). However, the higher sensitivity of delta-SUVmax for the early identification of responders may have an important clinical impact in guiding antibiotic therapy especially in patients with a noninformative CRP test at diagnosis.     

The value of [18F]FDG-PET in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease

Purpose This study was performed to investigate the value of ¹⁸F-fluorodeoxyglucose positron emission tomography ([¹⁸F]FDG-PET) in the diagnosis of large-vessel vasculitis and the assessment of activity and extent of disease.Methods Twenty-six consecutive patients (21 females, 5 males; median age – years, range 17–86 years) with giant cell arteritis or Takayasus arteritis were examined with [¹⁸F]FDG-PET. Follow-up scans were performed in four patients. Twenty-six age- and gender-matched controls (21 females, 5 males; median age 71 years, range 17–86 years) were included. The severity of large-vessel [¹⁸F]FDG uptake was visually graded using a four-point scale. C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured and correlated with [¹⁸F]FDG-PET results by logistic regression.Results [¹⁸F]FDG-PET revealed pathological findings in 18 of 26 patients. Three scans were categorised as grade I, 12 as grade II and 3 as grade III arteritis. Visual grade was significantly correlated with both CRP and ESR levels (p=0.002 and 0.007 respectively; grade I: CRP 4.0 mg/l, ESR 6 mm/h; grade II: CRP 37 mg/l, ESR 46 mm/h; grade III: CRP 172 mg/l, ESR 90 mm/h). Overall sensitivity was 60% (95% CI 40.6–77.3%), specificity 99.8% (95% CI 89.1–100%), positive predictive value 99.7% (95% CI 77–100%), negative predictive value 67.9% (95% CI 49.8–80.9%) and accuracy 78.6% (95% CI 65.6–88.4%). In patients presenting with a CRP <12 mg/l or an ESR <12 mm/h, logistic regression revealed a sensitivity of less than 50%. In patients with high CRP/ESR levels, sensitivity was 95.5%/80.7%.Conclusion [¹⁸F]FDG-PET is highly effective in assessing the activity and the extent of large-vessel vasculitis. Visual grading was validated as representing the severity of inflammation. Its use is simple and provides high specificity, while high sensitivity is achieved by scanning in the state of active inflammation.     

骨盆髋臼骨折患者围手术期炎症指标的变化及意义

目的探讨骨盆髋臼骨折患者围手术期白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)的变化及临床意义。方法笔者选取2014年1月~2014年12月收治的骨盆髋臼骨折手术患者18例,依据有无感染性并发症分为正常组14例(N组)及并发症组4例(C组),分别测定术前1d,术后即时,术后1、2、4、7d的IL-6、CRP、PCT以及体温、心率、呼吸、白细胞计数(WBC)。结果 (1)N组患者围手术期体温、呼吸、心率及白细胞计数均无统计学差异,C组患者围手术期体温、呼吸、心率变化不明显,WBC计数呈逐渐上升趋势。(2)N组患者IL-6水平术后即出现升高(较术前P0.05),术后1d时IL-6水平升高最为明显(P0.01);CRP水平术后即时与术前水平无显著差异,术后1d时CRP水平高于术前(P0.05),在术后2d时CRP水平升高最为明显(P0.01);PCT水平在术后均与术前水平无显著差异。C组2例患者术后早期IL-6、CRP、PCT水平变化趋势与N组相似,但三者均在术后7d再次出现显著升高。结论围手术期监测患者IL-6、CRP、PCT水平变化,有助于评估患者术后机体炎症反应状态、判断有无术后感染风险。     

Diagnostic significance of indium-111 granulocyte scintigraphy in febrile patients

Sixty-eight patients with fever of unknown origin, 32 patients with postoperative fever, and 26 patients with therapy-resistant fever after bacteremia were investigated with [111In] granulocyte scintigraphy for the detection of abscesses. The results showed that the value of [111In]granulocyte scintigraphy in the detection of infectious foci vary in these three types of febrile conditions. The overall sensitivity and specificity were 86.5% and 87.8%, respectively. We observed, however, a relatively low predictive value of a positive result in the fever of unknown origin group (73.1%), and also a low predictive value of a negative result in the bacteremia group (66.7%). The C-reactive protein (CRP) levels in patients with a true-positive scintigram were significantly (p less than 0.001) higher than in patients with a true-negative scintigram. There was also a significant positive correlation (p less than 0.01) between the serum CRP concentration and the intensity of the granulocyte accumulations. There was no correlation between the peripheral leukocyte count or the erythrocyte sedimentation rate (ESR) and the intensity of the granulocyte uptake. Therefore CRP, but not the leukocyte count or ESR, appears useful for selecting the patients who benefit most from granulocyte scintigraphy.     

Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction

We aimed to evaluate the possibility of hamstring tendon contamination, the correlation with clinical infection and its association with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in 89 anterior cruciate ligament reconstructions. Two tissue samples were obtained for culture from each graft: immediately after harvesting the graft and before implantation. The ESR and the CRP were evaluated preoperatively and on the 4th and 20th postoperative days. Nine patients (10%) had positive cultures but no patient had signs of postoperative infection. All patients had ESR and CRP values elevated at the 4th postoperative day. ESR and CRP values returned to normal levels at the 20th postoperative day. Higher mean values of CRP levels at the 4th day were observed in patients with contaminated grafts compared to those with uncontaminated. Both values reached normal levels at the 20th postoperative day.