降钙素原对原发性髋关节置换术患者围手术期感染的诊断价值分析
摘要点击次数: 64   全文下载次数: 20   投稿时间:2021-11-20    
作者Author单位AddressE-Mail
张善征 ZHANG Shan-zheng 衢化医院骨科, 浙江 衢化 324000 Department of Orthopaedics, Quhua Hospital, Quhua 324000, Zhejiang, China zsz13454007320@sina.com 
罗志军 LUO Zhi-jun 衢化医院骨科, 浙江 衢化 324000 Department of Orthopaedics, Quhua Hospital, Quhua 324000, Zhejiang, China  
叶凌 YE Ling 衢化医院骨科, 浙江 衢化 324000 Department of Orthopaedics, Quhua Hospital, Quhua 324000, Zhejiang, China  
期刊信息:《中国骨伤》2022年,第35卷,第11期,第1065-1069页
DOI:10.12200/j.issn.1003-0034.2022.11.011
基金项目:浙江省医药卫生科技计划(编号:2016RCA017)
中文摘要:

目的: 分析降钙素原(procalcitonin,PCT)对原发性髋关节置换术患者与植入物相关围术期感染的诊断价值。

方法: 回顾性研究2018年6月至2020年6月150例行原发性髋关节置换术的患者,男86例,女64例,年龄47~77(57.04±7.43)岁。150例原发性髋关节置换术患者根据术后是否发生感染,分为感染组和未感染组,于术前(D0)和术后第4、6、8天(分别为D4、D6、D8)从肘部静脉采集血样进行血清PCT水平及白细胞计数(white blood cell count,WBC)检测。

结果: 150例原发性髋关节置换术患者中,术后发生感染34例为感染组,未发生感染116例为未感染组。在感染组中,浅表外科手术部位感染19例(55.88%,19/34),尿路感染9例(26.47%,9/34),肺炎6例(17.65%,6/34)。感染组细菌培养后,金黄色葡萄球菌9例,大肠埃希菌3例,表皮葡萄球菌3例,星座链球菌3例,白色念珠菌3例,肺炎克雷伯杆菌6例,2例培养出大肠埃希菌和无乳链球菌,3例培养出凝固酶隐形葡萄球菌和洋葱伯克霍尔德菌,2例培养出大肠埃希菌、粪肠球菌和铜绿假单胞菌。两组患者PCT水平在D0(P=0.081)、D4(P=0.069)和D6(P=0.093)差异无统计学意义,但在D8差异有统计学意义(P=0.007)。两组间WBC在各时间点差异均无统计学意义(P>0.05)。受试者工作特征曲线(receiver operating characteristic curve,ROC)显示,PCT诊断原发性髋关节置换术后感染的曲线下面积(area under curve,AUC)=0.978,95%CI(0.933,1.022),WBC原发性髋关节置换术后感染的AUC=0.562,95%CI(0.398,0.726),PCT是原发性髋关节置换术后感染的重要预测因子(AUC>0.9),当临界值为0.526 ng/ml时,PCT诊断感染的敏感性为36%,特异性为100%,但WBC不是原发性髋关节置换术后感染的显著预测因子(0.59/L时,敏感性为64%,特异性为44%。

结论: PCT对原发性髋关节置换术患者围手术期感染具有较高的特异性,是一种很有前景的感染诊断指标。
【关键词】关节成形术,置换,髋  降钙素原  围手术期感染  诊断价值
 
Value of procalcitonin in the diagnosis of perioperative infection in patients undergoing primary hip replacement
ABSTRACT  

Objective: To analyze the value of procalcitonin (PCT) in the diagnosis of perioperative infection associated with implants in patients with primary hip arthroplasty.

Methods: A retrospective study was conducted on 150 patients who underwent primary hip arthroplasty from June 2018 to June 2020,including 86 males and 64 females,aged from 47 to 77 years old with an average of (57.04±7.43) years. All patients with primary hip arthroplasty were divided into infection group and non infection group according to whether there was infection after operation. Blood samples were collected from the elbow vein before operation (D0) and on the 4,6,8 days after operation(D4,D6 and D8) respectively to detect the serum PCT level and white blood cell count (WBC) level.

Results: Among 150 patients with primary hip arthroplasty,34 patients with postoperative infection were in the infection group,and 116 patients without postoperative infection were in the noninfection group. In the infection group,there were 19 cases of superficial surgical site infection(55.88%,19/34),9 cases of urinary tract infection (26.47%,9/34),and 6 cases of pneumonia(17.65%,6/34). After bacterial culture in the infection group,there were 9 cases of Staphylococcus aureus,3 cases of Escherichia coli,3 cases of Staphylococcus epidermidis,3 cases of Streptococcus constellation,3 cases of Candida albicans,6 cases of Klebsiella pneumoniae,2 cases of Escherichia coli and Streptococcus agalactis,3 cases of coagulase invisible staphylococcus and Burkholderia cepacia,2 cases of Escherichia coli,Enterococcus faecalis and Pseudomonas aeruginosa. There was no significant difference in PCT levels between two groups in D0(P=0.081),D4(P=0.069) and D6(P=0.093),but there was significant difference in D8(P=0.007). There was no significant difference in WBC between two groups at any time point(P>0.05). The results of receiver operating characteristic curve(ROC) showed that the AUC of PCT diagnosis was 0.978[95%CI(0.933,1.022)] and that of WBC was 0.562[95%CI(0.398,0.726)],PCT was an important predictor of infection after primary hip arthroplasty(AUC>0.9). When the critical value was 0.526 ng/ml,the sensitivity and specificity of PCT diagnosis are 36% and 100%,respectively,WBC was not a significant predictor of infection after primary hip arthroplasty (0.59/L,the sensitivity and specificity were 64% and 44%,respectively.

Conclusion: PCT has a high specificity for perioperative infection in patients with primary hip replacement,and it is a promising diagnostic index for infection.
KEY WORDS  Arthroplasty,replacement,hip  Procalcitonin  Perioperative infection  Diagnostic value
 
引用本文,请按以下格式著录参考文献:
中文格式:张善征,罗志军,叶凌.降钙素原对原发性髋关节置换术患者围手术期感染的诊断价值分析[J].中国骨伤,2022,35(11):1065~1069
英文格式:ZHANG Shan-zheng,LUO Zhi-jun,YE Ling.Value of procalcitonin in the diagnosis of perioperative infection in patients undergoing primary hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(11):1065~1069
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