红细胞沉降率和C反应蛋白在检测糖尿病足骨髓炎中的诊断价值；一项横断面研究。
Diagnostic Value of Erythrocyte Sedimentation Rate and C Reactive Protein in detecting Diabetic Foot Osteomyelitis; a Cross-sectional Study.
作者信息
Moallemi Seyed Kaveh, Niroomand Mahtab, Tadayon Niki, Forouzanfar Mohammad Mehdi, Fatemi Alireza
机构信息
AJA University of Medical Sciences, Tehran, Iran.
Division of Endocrinology, Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
出版信息
Arch Acad Emerg Med. 2020 Sep 8;8(1):e71. eCollection 2020.
INTRODUCTION
Osteomyelitis is one of the complications of diabetic foot infection. The present study aimed to evaluate the diagnostic value of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in detection of osteomyelitis in patients with diabetic foot.
METHODS
In this cross-sectional study, serum levels of ESR and CRP were measured for patients with diabetic foot referring to emergency department or endocrinology clinic and the screening performance characteristics of these markers in detection of osteomyelitis were calculated. The diagnosis of osteomyelitis was based on clinical examination and positive probe-to-bone test, which was confirmed by plain x-rays or MRI.
RESULTS
142 diabetic patients with an average age of 61.2 ± 11.8 years were evaluated (66.2 % male). The area under the ROC curve of ESR in detection of osteomyelitis in diabetic foot cases was 0.70 (95% CI: 0.62-0.79). The best ESR cut-off point in this regard was 49 mm/hour. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ESR in 49 mm/Hour cut-point were 74.6% (95% CI: 62.9-83.9), 57.7% (95% CI: 45.5-69.2), 63.9% (95% CI: 52.5-73.9), 69.5 % (95% CI: 56.0-80.0), 1.8 (95% CI: 1.3-2.4) and 0.4 (95% CI: 0.3-0.7), respectively. The area under the ROC curve of CRP in detection of osteomyelitis was 0.67 (95% CI: 0.58-0.76). The best cut-off point for CRP in this regard was 35 mg/liter with sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of 76% (95% CI: 64.2-85), 54.9% (95% CI: 42.7-66.6), 62.8% (95% CI: 51.6-72.8), 69.6% (95% CI: 51.7-80.8), 1.7 (95% CI, 1.3-2.2), and 0.4 (95% CI: 0.3-0.7), respectively.
CONCLUSION
Based on the findings of ROC curve analysis, ESR and CRP had fair and poor accuracy, respectively, in detecting the diabetic foot cases with osteomyelitis.
引言
骨髓炎是糖尿病足感染的并发症之一。本研究旨在评估红细胞沉降率（ESR）和C反应蛋白（CRP）在糖尿病足患者骨髓炎检测中的诊断价值。
方法
在这项横断面研究中，对前往急诊科或内分泌科就诊的糖尿病足患者测定血清ESR和CRP水平，并计算这些标志物在骨髓炎检测中的筛查性能特征。骨髓炎的诊断基于临床检查和阳性探骨试验，并通过X线平片或磁共振成像（MRI）确诊。
结果
共评估了142例糖尿病患者，平均年龄为61.2±11.8岁（男性占66.2%）。糖尿病足病例中ESR检测骨髓炎的ROC曲线下面积为0.70（95%可信区间：0.62 - 0.79）。在这方面，ESR的最佳截断点为49毫米/小时。ESR在49毫米/小时截断点时的敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比分别为74.6%（95%可信区间：62.9 - 83.9）、57.7%（95%可信区间：45.5 - 69.2）、63.9%（95%可信区间：52.5 - 73.9）、69.5%（95%可信区间：56.0 - 80.0）、1.8（95%可信区间：1.3 - 2.4）和0.4（95%可信区间：0.3 - 0.7）。CRP检测骨髓炎的ROC曲线下面积为0.67（95%可信区间：0.58 - 0.76）。在这方面，CRP的最佳截断点为33毫克/升，其敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比分别为76%（95%可信区间：64.2 - 85）、54.9%（95%可信区间：42.7 - 66.6）、62.8%（95%可信区间：51.6 - 72.8）、69.6%（95%可信区间：51.7 - 80.8）、1.7（95%可信区间：1.3 - 2.2）和0.4（95%可信区间：0.3 - 0.7）。
结论
基于ROC曲线分析结果，ESR和CRP在检测合并骨髓炎的糖尿病足病例时准确性分别为中等和较差。
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