Douraiswami Balaji, Dilip Patro K, Harish B N, Jagdish Menon
Departments of Orthopaedics and Microbiology, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, India.
J Orthop Surg (Hong Kong). 2012 Dec;20(3):381-5. doi: 10.1177/230949901202000325.
To measure C-reactive protein (CRP) and interleukin-6 (IL-6) levels in 30 patients with open fractures and correlate the levels with infection.
29 men and one woman aged 9 to 70 (mean, 37) years presented with open fractures of the upper or lower extremity within 12 hours of injury and underwent debridement and external fixation 3 to 40 (mean, 16) hours after injury. Serum CRP and IL-6 concentrations were measured preoperatively and on postoperative days 2 and 4. CRP was measured using latex agglutination and nephelometry, and IL-6 by enzyme-linked immunosorbent assay. The mean CRP and IL-6 levels in infected and non-infected patients were compared. The trend of CRP and IL-6 levels within the infected group was analysed. Correlations between CRP and infection, and between IL-6 and infection were analysed.
11 of the 30 patients developed wound infection. The day-2 CRP levels of 30 patients were positive (range, 7-28 µg/ml). In 27 patients, the CRP levels were higher on day 2 than preoperation. On day 4, CRP levels declined sharply in patients without infection (mean, 8 µg/ml) but were persistently elevated in patients with infection (mean, 17 µg/ml). The sensitivity and specificity of the CRP test were 100% and 42%, respectively. In the 11 patients with infection, the IL-6 concentrations were elevated at day 2 (mean, 689 pg/ml) and decreased progressively at day 4 (mean, 175 pg/ml). The sensitivity and specificity of the IL-6 test were 90% and 100%, respectively. Infection correlated with CRP and IL-6 levels.
Serial serum measurements of IL-6 and CRP levels help in the early diagnosis of infections after open fractures before they are clinically evident.
检测30例开放性骨折患者的C反应蛋白（CRP）和白细胞介素-6（IL-6）水平，并将这些水平与感染情况进行关联分析。
29名男性和1名女性，年龄9至70岁（平均37岁），在受伤后12小时内出现上肢或下肢开放性骨折，并在受伤后3至40小时（平均16小时）接受清创和外固定。术前以及术后第2天和第4天测量血清CRP和IL-6浓度。CRP采用乳胶凝集法和散射比浊法测量，IL-6采用酶联免疫吸附测定法测量。比较感染患者和未感染患者的平均CRP和IL-6水平。分析感染组内CRP和IL-6水平的变化趋势。分析CRP与感染之间以及IL-6与感染之间的相关性。
30例患者中有11例发生伤口感染。30例患者术后第2天的CRP水平均为阳性（范围为7 - 28μg/ml）。27例患者术后第2天的CRP水平高于术前。术后第4天，未感染患者的CRP水平急剧下降（平均8μg/ml），但感染患者的CRP水平持续升高（平均17μg/ml）。CRP检测的敏感性和特异性分别为100%和42%。在11例感染患者中，IL-6浓度在术后第2天升高（平均689pg/ml），并在术后第4天逐渐下降（平均175pg/ml）。IL-6检测的敏感性和特异性分别为90%和100%。感染与CRP和IL-6水平相关。
对IL-6和CRP水平进行系列血清检测有助于在开放性骨折后感染临床症状出现之前进行早期诊断。
