血清降钙素原、C反应蛋白、可溶性髓系细胞触发受体-1、可溶性白细胞分化抗原-14与骨折内固定术后感染的关系 研究

doi:10.19871/j.cnki.xfcrbzz.2025.02.007

摘要/Abstract

摘要： 目的探讨骨折内固定术后感染患者菌群分布及其与血清降钙素原（procalcitonin,PCT）、C反应蛋白（C-reactive protein,CRP）、可溶性髓系细胞触发受体-1（soluble myeloid cells trigger receptor-1,sTREM-1）、可溶性白细胞分化抗原-14（soluble cluster of differentiation antigen 14,sCD14）的关系。方法回顾性选取2021年3月至2024年3月在东南大学医学院附属南京同仁医院就诊的88例骨折内固定术后感染患者为感染组,另取同期经骨折内固定术治疗的88例术后无感染者为对照组。统计术后感染病原菌分布情况,比较不同菌群患者炎症指标;感染组与未感染组患者炎症指标,并分析炎症指标对诊断术后感染的价值;采用单因素和多因素回归分析影响骨折内固定术后患者感染的危险因素。结果 88例术后感染患者中,革兰氏阴性菌和革兰氏阳性菌分别占53.41%、46.59%,革兰氏阴性菌多见于大肠埃希菌（25.00%）,革兰氏阳性菌多见于金黄色葡萄球菌（23.86%）。88例术后感染患者单纯感染一种革兰氏阴性菌47例（革兰氏阴性菌组）,单纯感染一种革兰氏阳性菌41例（革兰氏阳性菌组）。与革兰氏阳性菌组比较,革兰氏阴性菌组患者PCT、CRP、sTREM-1、sCD14水平更高（均P<0.05）。与对照组比较,感染组患者PCT、CRP、sTREM-1、sCD14水平更高（均P<0.05）。ROC曲线结果显示,PCT、CRP、sTREM-1、sCD14联合诊断术后感染的AUC为0.956,高于单项诊断（P<0.05）。单因素分析显示,两组在切口类型、侵入性操作、糖尿病、低蛋白血症、术后抗菌药物使用时间、PCT、CRP、sTREM-1、sCD14比较,差异有统计学意义（均P<0.05）。多因素Logistic回归分析显示,糖尿病、低蛋白血症、术后抗菌药物使用时间>15d、PCT>101.13mg/L、CRP>72.61mg/L、sTREM-1>190.37mg/ml、sCD14>2.13μg/ml均是骨折内固定患者术后感染的独立危险因素（均P<0.05）。结论骨折内固定术后感染患者血清PCT、CRP、sTREM-1、sCD14水平均会升高,且革兰氏阴性菌感染患者炎症因子水平升高比革兰氏阳性菌患者更加明显,血清PCT、CRP、sTREM-1、sCD14联合诊断骨折内固定术后感染具有较高价值。

关键词: 骨折内固定, 血清降钙素原, C反应蛋白, 可溶性髓系细胞触发受体-1, 可溶性白细胞分化抗原-14, 术后感染

Abstract: Objective To explore bacterial distribution and their relationship with serum procalcitonin (PCT), C-reactive protein (CRP), soluble myeloid cells trigger receptor-1 (sTREM-1) and soluble cluster of differentiation antigen 14 (sCD14) in patients with infection after fracture internal fixation. Method A total of 88 patients with infection and 88 patients without infection after fracture internal fixation in Nanjing Tongren Hospital Affiliated to Southeast University School of Medicine were retrospectively enrolled as infection group and control group between March 2021 and March 2024, respectively. The distribution of postoperative infection pathogens was statistically analyzed. The inflammatory indexes were compared among patients with different pathogens and between infection group and control group, and their diagnostic value in postoperative infection was analyzed. The risk factors of postoperative infection in patients with fracture internal fixation were analyzed by univariate and multivariate regression analysis. Result In the 88 patients with postoperative infection, including Gram-negative bacteria [53.41%, mainly on Escherichia coli (25.00%)] and Gram-positive bacteria [46.59%, mainly on Staphylococcus aureus (23.86%)]. Among the 88 patients with postoperative infection, there were 47 cases with Gram-negative bacteria infection (Gram-negative bacteria group) and 41 cases with Gram-positive bacteria infection (Gram-positive bacteria group). The levels of PCT, CRP, sTREM-1 and sCD14 in Gram-negative bacteria group were higher than those in Gram-positive bacteria group (P<0.05). Compared with control group, levels of PCT, CRP, sTREM-1 and sCD14 were higher in infection group (all P<0.05). The results of ROC curves analysis showed that AUC of PCT combined with CRP, sTREM-1 and sCD14 in the diagnosis of postoperative infection was 0.956, greater than that of single index (P<0.05). Univariate analysis showed that there were significant differences in incision type, invasive operation, diabetes mellitus, hypoproteinemia, postoperative use time of antibiotics, PCT, CRP, sTREM-1 and sCD14 between the two groups (P<0.05). Multivariate Logistic regression analysis showed that diabetes mellitus, hypoproteinemia, postoperative antibiotics use time >15d, PCT >101.13mg/L, CRP >72.61mg/L, sTREM-1 >190.37mg/ml and sCD14 >2.13μg/ml were all independent risk factors of postoperative infection in patients with fracture internal fixation (P<0.05). Conclusion The levels of serum PCT, CRP, sTREM-1 and sCD14 are increased in patients with infection after fracture internal fixation, and the incease of inflammatory factors in patients with Gram-negative bacteria infection is more significant than those with Gram-positive bacteria infection. The combined detection of serum PCT, CRP, sTREM-1 and sCD14 has higher diagnostic value in infection after fracture internal fixation.

Key words: Fracture internal fixation, Serum procalcitonin, C-reactive protein, Soluble myeloid cell trigger receptor-1, Soluble cluster of differentiation antigen 14, Postoperative infection

中图分类号:

R378

戚荣富, 周杰, 谢曈, 尹海建. 血清降钙素原、C反应蛋白、可溶性髓系细胞触发受体-1、可溶性白细胞分化抗原-14与骨折内固定术后感染的关系研究[J]. 新发传染病电子杂志, 2025, 10(2): 35-39.

Qi Rongfu, Zhou Jie, Xie Tong, Yin Haijian. Relationship between serum procalcitonin, C-reactive protein, soluble myeloid cells trigger receptor-1, soluble cluster of differentiation antigen 14 and infection after fracture internal fixation[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(2): 35-39.

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