降钙素原、C-反应蛋白和血沉在膝关节炎化脓性感染中的诊断价值及意义

目的探讨降钙素原(PCT)、C-反应蛋白(CRP)和血沉(ESR)在膝关节炎化脓性感染早期诊断中的价值及意义,为临床诊治提供理论依据。方法选取2014年8月-2017年6月在本院住院疑似膝关节炎化脓性感染患者98例,经过关节液革兰染色涂片或者细菌培养,最后确诊化脓性关节炎32例(疾病组),非化脓性关节炎66例(对照组),对比2组血清PCT、CRP和血沉的变化情况,制作ROC曲线,用灵敏度和特异度来评价3者的诊断性能。结果疾病组外周血的PCT、CRP和ESR水平明显高于对照组,差异有统计学意义(P<0.01)。3组ROC面积比较后,PCT曲线下面积为0.915,明显高于ESR和CRP。PCT以1.67μg/L为截断值时,其灵敏度和特异度分别为84.38%和93.94%,灵敏度和特异度均优于CRP和ESR。结论PCT对膝关节炎化脓性感染的早期诊断价值优于CRP和ESR,可作为早期筛查的血清学指标。

Diagnostic value and significance of PCT,CRP and ESR in suppurative infection of knee

Objective To investigate the value and significance of procalcitonin in the early diagnosis of purulent infection of knee arthritis with procalcitonin,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR),and to provide a theoretical basis for clinical diagnosis and treatment.Methods From August 2014 to June 2017,98 patients(48-62 years old)with suspected purulent infection of knee joint were admitted in our hospital.After the synovial smear or bacterial culture of joint,we finally confirmed 32 cases of suppurative arthritis(case group)and 66 cases of non-suppurative arthritis(control group).The changes of serum PCT,CRP and erythrocyte sedimentation rate were compared between the two groups to make the ROC curve.The sensitivity and specificity were used to evaluate the diagnosis performance.Results The levels of PCT,CRP and ESR in peripheral blood in case group were significantly higher than those in control group,with the difference statistically significant(P<0.01).After comparing the three groups of ROC area,the area under the PCT curve was 0.9148,which was significantly higher than ESR and CRP.The sensitivity and specificity of PCT were 84.38%and 93.94%when the cut-off value of PCT was1.67μg/L.The sensitivity and specificity were superior to those of CRP and ESR.Conclusion PCT is superior to CRP and ESR in the early diagnosis of purulent infection of knee arthritis and can be used as a serological marker for early screening.