摘要
目的探讨血清可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)、高迁移率族蛋白B1(high mobility group box 1,HMGB1)对闭合性骨折患者内固定术后感染的预测价值。方法回顾性分析2017年7月至2019年11月于吉林省肿瘤医院行内固定术治疗的130例闭合性骨折患者的临床资料,根据患者术后切口是否发生感染将其分为感染组(68例)和未感染组(62例)。采用酶联免疫吸附测定检测患者术后1 d和术后3 d血清sICAM-1和HMGB1水平。采用Pearson相关分析探讨血清sICAM-1和HMGB1水平与闭合性骨折内固定术后感染的相关性,采用多因素Logistic回归分析探讨闭合性骨折患者内固定术后感染的影响因素。绘制受试者操作特征曲线分析血清sICAM-1和HMGB1水平对闭合性骨折患者内固定术后感染的预测价值。结果感染组患者白细胞计数、红细胞沉降率、降钙素原、C反应蛋白水平均显著高于未感染组(均P<0.05),止血带使用时间显著长于未感染组(P<0.001);术后1 d,两组患者血清sICAM-1、HMGB1水平比较差异均无统计学意义(均P>0.05);术后3 d,两组患者血清sICAM-1、HMGB1水平均显著高于本组术后1 d(均P<0.05),感染组患者血清sICAM-1、HMGB1水平均显著高于未感染组(均P<0.05);术后3 d,血清sICAM-1、HMGB1水平与止血带使用时间、降钙素原、C反应蛋白、白细胞计数和红细胞沉降率均呈显著正相关(均P<0.01)。多因素Logistic回归分析显示,止血带使用时间、血清sICAM-1和HMGB1水平均是闭合性骨折患者内固定术后感染的独立危险因素(均P<0.001);sICAM-1与HMGB1联合诊断闭合性骨折患者内固定术后感染的灵敏度和特异度分别为94.29%和92.59%。结论血清sICAM-1和HMGB1水平升高均是闭合性骨折患者内固定术后感染的独立危险因素,二者联合可作为预测术后感染的潜在血清标志物。
Objective To explore the predictive value of serum soluble intercellular adhesion molecule-1(sICAM-1)and high mobility group box 1(HMGB1)for infection after internal fixation in patients with closed fracture.Method The clinical data of 130 cases of closed fracture patients treated with internal fixation in Jilin Cancer Hospital from July 2017 to November 2019 were retrospectively analyzed,and they were divided into infected group(68 cases)and non-infected group(62 cases)according to whether the incisions were infected after operation.Enzyme-linked immunosorbent assay was used to determine the serum sICAM-1 and HMGB1 of the patients one day and three days after operation.Pearson correlation analysis was used to explore the correlation between serum sICAM-1 and HMGB1 levels and infection after internal fixation in patients with closed fracture.Multivariate Logistic regression analysis was used to explore the influencing factors for infection after internal fixation in patients with closed fracture.Receiver operating characteristic curve was plotted to analyze the diagnostic value of serum sICAM-1 and HMGB1 levels for infection after internal fixation in patients with closed fracture.Result The white blood cell count,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),and C reactive protein(CRP)in infected group were significantly higher than those in non-infected group(all P<0.05),and the tourniquet use time was significantly longer than that in non-infected group(P<0.001).One day after operation,there were no significant differences in serum sICAM-1 and HMGB1 levels between the two groups(all P>0.05);three days after operation,the serum sICAM-1 and HMGB1 levels of the two groups were significantly higher than this group one day after operation(all P<0.05),the serum sICAM-1 and HMGB1 levels in infected group were significantly higher than those in non-infected group(all P<0.05).Three days after operation,serum sICAM-1 and HMGB1 levels were significantly positively correlated with tourniquet use time,PCT,CRP,white blood cell count and ESR(all P<0.01).Multivariate Logistic regression analysis showed that tourniquet use time,sICAM-1 and HMGB1 were all independent risk factors for infection after internal fixation in patients with closed fracture(all P<0.001).The sensitivity and specificity of sICAM-1 combined with HMGB1 in the diagnosis of postoperative infection in patients with closed fracture after internal fixation were 94.29%and 92.59%,respectively.Conclusion Elevated serum sICAM-1 and HMGB1 levels are independent risk factors for infection after internal fixation in patients with closed fracture,and the combination of the two indicators can be used as potential serum markers for predicting postoperative infection.
作者
苑学军
张健
孙洪帅
任宪伟
Yuan Xuejun;Zhang Jian;Sun Hongshuai;Ren Xianwei(Clinical Laboratory,Jilin Cancer Hospital,Changchun 130012,China;Department of Thoracic Surgery,Jilin Cancer Hospital,Changchun 130012,China)
出处
《中国医学前沿杂志（电子版）》
2021年第8期49-53,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
