Ernst Amy A, Weiss Steven J, Tracy Lori-Ann, Weiss Natalie R
Department of Emergency Medicine, University of New Mexico and Albuquerque Academy, Albuquerque, NM 87131-001, USA.
South Med J. 2010 Jun;103(6):522-6. doi: 10.1097/SMJ.0b013e3181ddd246.
To determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or a combination of both was better in diagnosing a septic joint.
A retrospective chart review was done in all patients who had serum assays for ESR or CRP as well as joint fluid analysis over a two-year period. Based on lab and operative findings, patients (cohorts) were categorized as having normal, inflammatory, or septic joints. Sensitivities (SEN), specificities (SP), positive and negative predictive values (PPV, NPV) were obtained using our lab's positive cutoffs of 15 for ESR and 0.8 for CRP. Contingency tables were used for comparisons between predictor variables and the presence of septic joints. Receiver operator curves (ROC) were obtained for CRPs and ESRs.
Of 163 patients, 72 had inflammatory joints, 44 had septic joints, and 47 were normal. Fifteen admitted to drug use and 43 to alcohol consumption. There were 120 males and 42 females. The mean CRP for septic joints was 13, 8.5 for inflammatory joints, and 6 for normal. The mean ESR for septic joints was 57, 48 for inflammatory joints, and 43 for normal joints. By univariate analysis, drug use and elevated CRPs were significantly associated with septic joints while alcohol use, ESRs, and gender were not. A regression model with 4 variables indicated that drug use and CRP were predictive of septic joint; alcohol and ESR were not.
CRP is helpful in determining the presence of a septic joint; ESR is not.
确定红细胞沉降率（ESR）、C反应蛋白（CRP）或两者联合检测在诊断化脓性关节方面是否更具优势。
对在两年期间进行了ESR或CRP血清检测以及关节液分析的所有患者进行回顾性病历审查。根据实验室和手术结果，将患者（队列）分为关节正常、炎性或化脓性三类。使用我们实验室设定的ESR阳性临界值15和CRP阳性临界值0.8来获得敏感度（SEN）、特异度（SP）、阳性和阴性预测值（PPV、NPV）。列联表用于预测变量与化脓性关节存在情况之间的比较。获得CRP和ESR的受试者工作特征曲线（ROC）。
163例患者中，72例有关节炎，44例有化脓性关节，47例关节正常。15例承认有药物使用史，43例有饮酒史。男性120例，女性42例。化脓性关节的平均CRP为13，炎性关节为8.5，正常关节为6。化脓性关节的平均ESR为57，炎性关节为48，正常关节为43。单因素分析显示，药物使用和CRP升高与化脓性关节显著相关，而饮酒、ESR和性别则无此关联。一个包含4个变量的回归模型表明，药物使用和CRP可预测化脓性关节；饮酒和ESR则不能。
CRP有助于确定化脓性关节的存在；ESR则不然。
