摘要
目的 探讨C反应蛋白/白蛋白(CAR)、前白蛋白(PA)和中性粒细胞/淋巴细胞比值(NLR)对踝关节骨折术后并发感染的预测价值.方法 选择2016年1月至2021年12月在温州市中西医结合医院行内固定术治疗的踝关节骨折患者100例为研究对象,选取同期在该院健康体检人员100例为对照组.采用回顾性研究方法,依据术后是否发生感染将患者分为非感染组(n=75)和感染组(n=25).比较各组外周血CAR、PA、NLR水平变化.采用受试者工作特征曲线(ROC曲线)分析CAR、PA、NLR水平对踝关节骨折患者术后感染的预测效能.结果 术后3d,感染组患者外周血CAR、NLR 分别为 2.28±0.23、8.86±1.27,均高于对照组的 0.25±0.05、1.95±0.25,而 PA[(162.15± 30.86)mg/L]低于对照组的(208.03±39.09)mg/L,差异均有统计学意义(t=86.25、53.38、9.21,均P＜0.001);感染组外周血CAR、NLR分别为2.35±0.29、9.83±1.70,均高于非感染组的2.12±0.07、7.62± 0.85,而 PA 为(132.82±25.20)mg/L,低于非感染组的(168.06±31.19)mg/L(t=6.39、8.55、5.11,均P＜0.001).ROC曲线分析发现,CAR的曲线下面积(AUC)为0.809,CPR的AUC为0.781,NLR的AUC为0.777,三者联合的AUC为0.893,三者联合的AUC大于CAR、PA、NLR单独AUC(P＜0.05).结论 踝关节骨折术后感染患者外周血CAR、NLR水平均升高,PA水平降低.其中,CAR对踝关节骨折术后感染预测价值最高,三者联合可使预测效能进一步提升.
Abstract
Objective To investigate the predictive value of C-reactive protein/albumin ratio(CAR),prealbumin(PA)and neutrophil/lymphocyte ratio(NLR)for postoperative infection in patients with ankle fractures.Methods A total of 100 patients with ankle fractures who underwent internal fixation at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital between January 2016 and December 2021 were selected as the study subjects.Additionally,100 patients who underwent routine physical examinations at the hospital during the same period were included in the healthy control group.The patients were retrospectively divided into a non-infection group(n=75)and an infection group(n=25)based on the occurrence of postoperative infection.The levels of CAR,PA,and NLR in peripheral blood were compared among the groups.The predictive efficiency of serum CAR,PA,and NLR for postoperative infection in patients with ankle fractures was analyzed using the receiver operating characteristic curve(ROC).Results Three days after surgery,CAR and NLR in peripheral blood of the infection group were 2.28±0.23 and 8.86±1.27,respectively.These values were significantly higher compared with those in the healthy control group,which were 0.25±0.05 and 1.95±0.25,respectively(t=86.25,53.38,both P＜0.001).Additionally,the level of PA in peripheral blood of the infection group was(162.15±30.86)mg/L,which was significantly lower than that in the control group[(208.03±39.09)mg/L,t=9.21,P＜0.001].CAR and NLR in the peripheral blood of patients in the infection group were 2.35±0.29 and 9.83±1.70,respectively.These values were significantly higher than those in the non-infection group(2.12±0.07,7.62±0.85,t=6.39,8.55,both P＜0.001).The level of PA in the peripheral blood of patients in the infection group was(132.82±25.20)mg/L,which was significantly lower than that in the non-infection group[(168.06±31.19)mg/L,t=5.11,P＜0.001].The receiver operating characteristic curve analysis revealed that the area under the curve(AUC)was 0.809 for CAR,0.781 for CRP,and 0.777 for NLR.When the three markers were used in combination,the AUC increased to 0.893.The AUC value for the combined markers was significantly higher than those for CAR,PA,and NLR alone(all P＜0.05).Conclusion The values of CAR and NLR in peripheral blood increase in patients with ankle fractures who develop post-surgical infections,whereas the level of PA decreases.Among these markers,CAR exhibits the highest predictive value for postoperative infection in ankle fractures.Furthermore,the combined use of these three markers can significantly enhance the predictive efficiency.
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