ESR、CRP和COX-2对骨科创伤术后感染诊断价值及与SIRS相关性

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摘要目的探究血清红细胞沉降率(erythrocyte sedimentation rate，ESR)、C反应蛋白(C-reactive protein，CRP)、环氧合酶-2(cycloxygenase-2，COX-2)指标水平对骨科开放性损伤患者术后感染诊断价值与全身炎症反应综合征(systemic inflammatory response syndrome，SIRS)评分的相关性。方法选取中国人民武装警察部队重庆市总队医院骨科2019年7月至2022年7月诊治的98例骨科开放性损伤患者作为研究对象，根据患者术后是否感染分为感染组和未感染组。感染组43例，男25例，女18例；年龄21~65岁，平均(56.19±4.33)岁。未感染组55例，男29例，女26例；年龄21~66岁，平均(56.37±4.49)岁。采用双抗体酶联免疫吸附剂测定(enzyme linked immuno sorbent assay，ELISA)检测患者血清ESR、CRP和COX-2水平；对患者行常规血液检查和生命体征的监测，计算SIRS评分；对比两组ESR、CRP和COX-2水平；分析血清ESR、CRP和COX-2对骨科创伤患者术后感染诊断价值；对比骨科创伤感染组和未感染组手术前后SIRS评分差异；Pearson分析ESR、CRP和COX-2与SIRS评分相关性。结果术后两组ESR、CRP和COX-2水平均升高，且感染组表达明显高于未感染组(P＜0.05)；ESR、CRP和COX-2联合检测在骨科术后感染患者中诊断评估中的受试者工作特征(receiver operating characteristic，ROC)曲线下面积(area under curve，AUC)为0.899，具有较高的特异性以及敏感度，显著高于单独ESR、CRP检测，且联合诊断对骨科术后感染患者具有高度一致性(P＜0.05)；术后3 d两组SIRS评分均升高，且感染组评分明显高于未感染组(P＜0.05)；Pearson分析骨折术后感染患者ESR、CRP和COX-2与SIRS评分相关性，发现均与SIRS评分存在显著正相关(P＜0.001)。结论血清ESR、CRP和COX-2在骨科术后感染患者中呈现高表达，联合检测对患者感染发生诊断价值较高；且血清ESR、CRP和COX-2与SIRS评分呈现显著正相关，临床可对患者实行指标及时检测，以降低术后感染的发生率。

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	余青洲
	王扬
	雷涛
	黄翮
	邵方源
	方超
	邓淼

关键词 ：红细胞沉降率, C反应蛋白, 环氧合酶-2, 全身炎症反应综合征评分, 诊断价值

Abstract：

Objective To explore the diagnostic value of serum erythrocyte sedimentation rate(ESR)，C-reactive protein(CRP) and cyclocyception-2(COX-2) indexes in postoperative infection of orthopaedic trauma patients and their correlation with systemic inflammatory response syndrome(SIRS) score.Methods Ninety-eight patients with open orthopaedic injuries who were treated and treated in the orthopaedic department of Chongqing General Hospital of the Chinese People’s Armed Police Force from July 2019 to July 2022 were selected as the study objects，and were divided into infected group and uninfected group according to whether the patients were infected after surgery.There were 43 cases in the infected group，including 25 males and 18 females.The average age was (56.19±4.33) years，ranging from 21 to 65 years.There were 55 cases in the uninfected group，including 29 males and 26 females.The average age was (56.37±4.49) years，ranging from 21 to 66 years.Serum ESR，CRP and COX-2 levels were detected by enzyme linked immuno sorbent assay (ELISA).The patients underwent routine blood tests and vital signs monitoring，and SIRS score was calculated；The levels of ESR，CRP and COX-2 in the infected and uninfected groups were compared.The diagnostic value of serum ESR，CRP and COX-2 in postoperative infection of orthopaedic trauma patients was analyzed.The difference of SIRS scores before and after surgery was compared between infected and uninfected orthopaedic trauma groups.The correlation between ESR，CRP and COX-2 and SIRS score was analyzed by Pearson.Results After operation，the levels of ESR，CRP and COX-2 increased in both groups，and the expression of infected group was significantly higher than that of uninfected group (P＜0.05).The AUC under the ROC curve of ESR，CRP and COX-2 combined test was 0.899 in the diagnostic evaluation of patients with postoperative infection in orthopaedics，which had high specificity and sensitivity，and was significantly higher than that of ESR and CRP alone，and the combined diagnosis was highly consistent in patients with postoperative infection in orthopaedics (P＜0.05).3 days after operation，SIRS scores of both groups increased，and the score of infected group was significantly higher than that of non-infected group (P＜0.05).Pearson analysis of the correlation between ESR，CRP and COX-2 and SIRS score in postoperative infection patients showed significant positive correlation with SIRS score (all P＜0.001).Conclusion Serum ESR，CRP and COX-2 are highly expressed in infected patients after orthopaedic surgery.Combined detection is of high value in the diagnosis of infection.In addition，serum ESR，CRP and COX-2 showed a significant positive correlation with SIRS score，indicating that timely detection of indicators could be carried out to reduce the incidence of postoperative infection.

Key words： erythrocyte sedimentation rate C-reactive protein cyclooxygenase-2 systemic inflammatory response syndrome score diagnostic value

通讯作者: 邓淼

作者简介: 余青洲(1986－ )，男，主治医师，中国人民武装警察部队重庆市总队医院骨科，33132638@qq.com

引用本文:

余青洲，王扬，雷涛，黄翮，邵方源，方超，邓淼. ESR、CRP和COX-2对骨科创伤术后感染诊断价值及与SIRS相关性[J]. 实用骨科杂志, 2024, 30(1): 34-.
Yu Qingzhou，Wang Yang，Lei Tao，Huang He，Shao Fangyuan，Fang Chao，Deng Miao. Diagnostic Value of ESR，CRP and COX-2 for Postoperative Infection in Orthopaedic Trauma and Correlation with SIRS. sygkzz, 2024, 30(1): 34-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I1/34

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