人工髋关节置换术后深部感染病原分布及炎症介质的早期预测诊断价值

The distribution of deep infection pathogens after artificial hip arthroplasty and the early diagnostic value of inflammatory factors

  • 摘要: 目的 对行人工髋关节置换术后早期并发假体深部感染患者的感染病原菌进行分析,并观察术后人工髋关节置换术后患者外周血炎症因子水平的变化,以期为临床诊疗提供参考。方法 纳入分析2010年9月-2017年8月医院50例接受人工髋关节置换术并发早期假体深部感染(感染组)患者的临床资料,另纳入同期医院60例接受人工髋关节置换术未并发感染(未感染组)患者的临床资料,分析感染组患者深部感染病原菌的种类及构成比。观察两组患者外周血白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、降钙素原(PCT)水平,探讨其对人工髋关节置换术后患者早期并发深部感染的诊断价值。结果 50例感染组患者共分离出病原菌55株,其中革兰阳性菌31株占56.36%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌为主;革兰阴性菌24株占43.64%,以大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌为主;感染组患者血清IL-6、PCT水平均高于未感染组患者(P<0.05);ROC曲线分析显示:IL-6在诊断人工髋关节置换术后早期并发深部感染的最佳阈值为20.37pg/ml,其敏感性为66.67%,特异性为66.04%;PCT在诊断人工髋关节置换术后早期并发深部感染的最佳阈值为3.12 μg/L,其敏感性为65.24%,特异性为62.23%。结论 人工髋关节置换术后患者早期易并发深部感染,外周血炎症因子IL-6、PCT对人工髋关节置换术后早期深部感染具有一定的诊断价值。

     

    Abstract: OBJECTIVE To explore the pathogen distribution and the changes in peripheral blood inflammatory factors after artificial hip arthroplasty,so as to provide reference in clinical diagnosis and treatment. METHODS Clinical data of 50 patients with deep infection after artificial hip arthroplasty at our hospital from Sep. 2010 to Aug. 2017 were analyzed. Another 64 cases of non-infected patients at our hospital in the same time period were taken as control. The pathogen types and distribution were analyzed in the infection group. The peripheral blood levels of IL-6, IL-10, PCT in the two groups were observed, and their diagnostic value in infected patients after artificial hip arthroplasty was analyzed. RESULTS 55 strains of pathogens were isolated from the 50 infected patients, including 31 strains (56.36%) of gram-positive bacteria, dominated by Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus faecalis, and 24 strains (43.64%) of gram-negative bacteria, dominated by Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa. The serum levels of IL-6 and PTC in the infected was significantly higher groups than those of the control group (P<0.05). ROC analysis showed that the cut-off point value of IL-6 was 20.37 pg/ml when used for diagnosis of early deep infection after artificial hip arthroplasty, which provided a sensitivity of 66.67%% and a specificity of 66.04%. The PTC cut-off point value was 3.12 μg/L when used for diagnosis of early deep infection after artificial hip arthroplasty, which provided a sensitivity of 65.24% and a specificity of 62.23%. CONCLUSION Patients after artificial hip arthroplasty are prone to deep infection, and the serum levels of IL-6 and PCT have certain diagnostic value in patients with early deep infection after artificial hip arthroplasty.

     

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