NAP-PCT-CRP联合检测对骨科术后感染的诊断价值
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摘要
目的探讨NAP、PCT、CRP联合检测对骨科术后感染的诊断价值。方法选择2016年6月～2018年1月收治的骨科行Ⅱ类手术患者304例,按照是否感染分为感染组42例和非感染组262例。2组受试对象于术后第1天收集肘外周静脉血5mL,采用双抗夹心免疫化学发光法检测PCT,免疫荧光干式定量法检测CRP,NAP检测采用NAP底物-AMP缓冲液法;感染组收集2次标本,置于10mL无菌试管内,采用药敏试验纸片扩散法(K-B法)对病原菌进行鉴定。根据NAP、PCT、CRP绘制ROC曲线,在最佳截断值下计算各指标曲线下面积(AUC),并据此评价各指标及联合诊断的效能。结果 304例骨科患者术后发生感染42例,感染率13.8%;42例骨科感染患者中共分离出89株病原菌,其中革兰阳性菌39株占43.8%,革兰阴性菌37株占41.6%,病毒4株占4.5%,支原体6株占6.7%,其他菌株3株占3.4%;感染组的NAP积分、NAP阳性率、PCT及CRP均明显高于非感染组,差异有统计学意义(P <0.05)。NAP、PCT、CRP联合检测对骨科术后感染诊断的AUC为0.928,明显高于NAP、PCT、CRP单项检测(AUC:0.667、0.779、0.877,均P <0.01),提示NAP、PCT、CRP联合对骨科术后感染具有较高的诊断价值。结论 NAP、PCT、CRP联合检测对骨科术后感染诊断具有重要的临床价值,能够作为骨科术后感染诊断和疗效判断的重要依据。
Objective To investigate the diagnostic significance of combined detection of NAP,PCT and CRP in orthopedic postoperative infection.Methods Three hundred and four inpatients who had received Class Ⅱ treatments were divided into infection group(262 cases) and non-infection group(42 cases) from June 2016 to January 2018.5 mL of venous blood was collected on the first day postoperation.PCT was detected by double-antibody sandwich immunochemiluminescence assay,CRP was tested by immunofluorescence dry-quantitative assay,and NAP assay was carried out with NAP substrate-AMP buffer method.Antibiotic sensitive tests were performed with disc diffusion assay(K-B method).The ROC curves were analyzed according to the expression levels of NAP,PCT and CRP.Results Among 304 orthopedic patients,42(13.8%) had postoperative infections,from whom 89 strains of bacteria were isolated that included 39(43.8%) G-positive and 37(41.6%) G-negative bacteria,4(4.5%) viruses,6(6.7%) mycoplasma,and 3(3.4%) unidentified microbes.The infection group was significantly higher than the non-infection group in terms of NAP scores,NAP positive rate,PCT and CRP(P <0.05).The combined detections of NAP,PCT,and CRP for postoperative orthopedic infection was AUC:0.928,which was significantly higher than that of NAP,PCT,and CRP(AUC:0.667,0.779,0.877,P <0.01),suggesting that joint detections of NAP,PCT,and CRP help with the diagnosis in orthopedics postoperative infection.Conclusion Combined detections of NAP,PCT and CRP are clinically valuable in the diagnosis of orthopedic postoperative infection.
Objective To investigate the diagnostic significance of combined detection of NAP,PCT and CRP in orthopedic postoperative infection.Methods Three hundred and four inpatients who had received Class Ⅱ treatments were divided into infection group(262 cases) and non-infection group(42 cases) from June 2016 to January 2018.5 mL of venous blood was collected on the first day postoperation.PCT was detected by double-antibody sandwich immunochemiluminescence assay,CRP was tested by immunofluorescence dry-quantitative assay,and NAP assay was carried out with NAP substrate-AMP buffer method.Antibiotic sensitive tests were performed with disc diffusion assay(K-B method).The ROC curves were analyzed according to the expression levels of NAP,PCT and CRP.Results Among 304 orthopedic patients,42(13.8%) had postoperative infections,from whom 89 strains of bacteria were isolated that included 39(43.8%) G-positive and 37(41.6%) G-negative bacteria,4(4.5%) viruses,6(6.7%) mycoplasma,and 3(3.4%) unidentified microbes.The infection group was significantly higher than the non-infection group in terms of NAP scores,NAP positive rate,PCT and CRP(P <0.05).The combined detections of NAP,PCT,and CRP for postoperative orthopedic infection was AUC:0.928,which was significantly higher than that of NAP,PCT,and CRP(AUC:0.667,0.779,0.877,P <0.01),suggesting that joint detections of NAP,PCT,and CRP help with the diagnosis in orthopedics postoperative infection.Conclusion Combined detections of NAP,PCT and CRP are clinically valuable in the diagnosis of orthopedic postoperative infection.
引文
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13向忠,贺建军,唐长友,等.动态监测PCT、WBC、E S R、h s C R P诊断骨科内固定术后早期切口感染[J].中国骨与关节损伤杂志,2017,32(9):1002-1004.
14张柘,沈颖,郑勇,等.血清CRP与PCT和红细胞沉降率对骨科肿瘤患者术后感染的诊断意义[J].中华医院感染学杂志,2016,26(9):2024-2026.
15高建清,黄小敬,袁健东,等.C-反应蛋白与降钙素原对骨折患者术后感染的诊断价值[J].中华医院感染学杂志,2015,(10):2174-2175.2178.
16丁红,朱星成,迟锦瑜,等.NAP、PCT、hs-CRP检测在鉴别感染类型中的价值[J].检验医学,2017,32(10):894-897.
2谢朝云,闫飞,熊永发,等.骨科患者医院感染与社区感染金黄色葡萄球菌的耐药性分析[J].中国微生态学杂志,2017,29(2):171-174.178.
3杨嘉骏,姜楠,余斌,等.不同炎性反应因子在骨科内植物术后感染中诊断价值的研究进展[J].中华创伤骨科杂志,2016,18(12):1057-1063.
4王婷婷,孙伟鹏,梁爽,等.降钙素原诊断成人骨关节感染的M e t a分析[J].中国组织工程研究,2 0 1 7,2 1(31):5078-5084.
5范国明,贾少华,周红梅,等.中性粒细胞碱性磷酸酶对骨科患者感染的诊断研究[J].中华医院感染学杂志,2017,27(14):3244-3247.
6张鑫,李慧娟,周亮,等.骨科术后感染临床治疗分析[J].实用药物与临床,2016,19(1):58-61.
7 Bohra S,Kundu D,Naskar M K,et al.Synthesis of cashew nut-like zeolite NaP powders using agro-waste material as silica source[J].Materials Letters,2013,106(9):182-185.
8 Scarlat M M,Mavrogenis A F,Pecina M,et al.Impact and alternative metrics for medical publishing:our experience with International Orthopaedics[J].Int Orthop,2015,39(8):1459-1464.
9 Logan C,Hess A,Kwon J Y,et al.Damage control orthopaedics:Variability of construct design for external fixation of the lower extremity and implications on cost[J].Injury,2015,46(8):1533-1538.
10 Leopold S S.Editorial:Case closed-discontinuing case reports in clinical orthopaedics and related research(R)[J].Clin Orthop Relat Res,2015,473(10):3074-3075.
11 Pecina M.International orthopaedics today[J].Int Orthop,2015,39(3):381-382.
12黄凯.CRP与ESR在骨科内固定手术后的表达变化及意义[J].标记免疫分析与临床,2016,23(8):874-877.
13向忠,贺建军,唐长友,等.动态监测PCT、WBC、E S R、h s C R P诊断骨科内固定术后早期切口感染[J].中国骨与关节损伤杂志,2017,32(9):1002-1004.
14张柘,沈颖,郑勇,等.血清CRP与PCT和红细胞沉降率对骨科肿瘤患者术后感染的诊断意义[J].中华医院感染学杂志,2016,26(9):2024-2026.
15高建清,黄小敬,袁健东,等.C-反应蛋白与降钙素原对骨折患者术后感染的诊断价值[J].中华医院感染学杂志,2015,(10):2174-2175.2178.
16丁红,朱星成,迟锦瑜,等.NAP、PCT、hs-CRP检测在鉴别感染类型中的价值[J].检验医学,2017,32(10):894-897.