Jenny J Y, Gaudias J, Bourguignat A, Férard G, Kempf I
Centre de Traumatologie et d'Orthopédie, Illkirch.
Rev Chir Orthop Reparatrice Appar Mot. 1999 Jul;85(4):321-7.
The authors investigated the value of C-reactive protein (CRP) and transthyretin (TTR) in the early diagnosis of infection after open fractures of the lower limb in an open, prospective study.
Eighty patients were treated with acute debridement and bone fixation. Follow-up included clinical, radiological, bacteriological and biological assessment: white cell blood count (WBC), erythrocyte sedimentation rate (ESR), CRP and TTR. Diagnosis of infection was based on macroscopic presence of pus.
Post-operative reference biological profiles were defined in 74 cases without infection. Reference profiles of WBC and ESR showed unreliable interindividual variations and could not be considered for the diagnosis of infection. Reference profiles of CRP and TTR showed a respective increase (for CRP) and decrease (for TTR) in the early post-operative course, with return to normal values after 12 days. In 6 infected patients, CRP concentrations were suddenly increased and TTR concentrations decreased at the time (3 cases) or even before (3 cases) clinical diagnosis of infection. These variations were mostly simultaneous. No unusual profile was found. The ratio of CRP/TTR concentrations experienced also a sudden increase in infected cases.
Because of not specifical and unreliable variations in the post-operative outcome of non infected patients, WBC and ESR cannot be considered for the early diagnosis of infection. CRP and TTR concentrations with a respective cut-off value of 100 mg/L and 120 mg/L were found efficient for the early diagnosis of infection, and preceded clinical diagnosis in three of them. A CRP/TTR ratio over 60 p. 100, 8 days or more after initial surgery was found to be very specific (93 p. 100) and sensitive (100 p. 100) for the diagnosis of infection.
Serial quantifications of CRP and TTR should be performed every four days during the follow-up of open fractures in order to early diagnose a post-operative infection. Comparison of both CRP and TTR could allow a higher accuracy, because of the possible lack of variation of one the two markers.
作者在一项开放性前瞻性研究中，调查了C反应蛋白（CRP）和转甲状腺素蛋白（TTR）在下肢开放性骨折后感染早期诊断中的价值。
80例患者接受了急性清创和骨固定治疗。随访包括临床、放射学、细菌学和生物学评估：白细胞计数（WBC）、红细胞沉降率（ESR）、CRP和TTR。感染的诊断基于肉眼可见的脓液。
74例未感染患者确定了术后参考生物学指标。WBC和ESR的参考指标显示个体间差异不可靠，不能用于感染的诊断。CRP和TTR的参考指标在术后早期分别呈现升高（CRP）和降低（TTR），12天后恢复正常。6例感染患者中，在感染临床诊断时（3例）甚至之前（3例），CRP浓度突然升高，TTR浓度降低。这些变化大多同时出现。未发现异常指标。感染病例中CRP/TTR浓度比值也突然升高。
由于未感染患者术后结果变化不特异且不可靠，WBC和ESR不能用于感染的早期诊断。发现CRP和TTR浓度分别以100mg/L和120mg/L为临界值，对感染的早期诊断有效，其中3例先于临床诊断。发现初次手术后8天或更长时间，CRP/TTR比值超过60 p. 100对感染诊断非常特异（93 p. 100）且敏感（100 p. 100）。
在开放性骨折随访期间，应每四天进行一次CRP和TTR的连续定量检测，以便早期诊断术后感染。比较CRP和TTR可提高准确性，因为这两种标志物可能存在一种缺乏变化的情况。
