摘要目的:分析血清C-反应蛋白(CRP)、降钙素原(PCT)和中性粒细胞CD64在四肢骨折内固定术后早期感染中的预测价值。方法:收集2016年1月至2022年12月在泰顺县人民医院骨科行手术治疗的四肢骨折患者2 572例，根据术后是否发生感染分为未感染组( n＝2 451例)和感染组( n＝121例)，抽取所有患者入院时及术后第1、3、5和第7天外周静脉血，检测PCT、CRP和CD64水平。采用重复测量方差分析比较两组患者不同时间点血清PCT、CRP和CD64水平，采用受试者工作特征曲线(ROC)进一步比较各项指标对四肢骨折内固定术后早期感染的预测价值。 结果:2 572例骨折手术患者出现早期感染121例，感染发生率为4.70%。感染组PCT、CRP和CD64水平术后开始上升，第7天开始下降，在术后第3、第5和第7天与未感染组相比差异均有统计学意义(PCT： F时间＝678.607， F组间＝2 218.323, F交互＝653.150；CRP ： F时间＝392.724、 F组间＝1 812.502， F交互＝379.577；CD64： F时间＝373.686， F组间＝4 817.438， F交互＝528.353， P值均<0.001)。以PCT、CPR和CD64术后第3天的检测值绘制ROC曲线，发现PCT、CPR和CD64联合检测的ROC曲线下面积为0.856，敏感度和特异度分别为69.2%和94.7%。三项指标联合检测效果优于PCT、CRP和CD64单独检测( Z＝6.176、3.838和2.431， P<0.01或<0.05)，且优于PCT和CRP联合检测( Z＝2.875， P＝0.019)。 结论:CD64、PCT和CRP指标联合检测可提高骨折术后感染早期诊断的准确性，值得在临床上推广应用。

abstractsObjective:To investigate serum C-reactive protein (CRP) , procalcitonin (PCT) and neutrophil CD64 in predicting early infection after internal fixation of limb fractures.Methods:A total of 2 572 patients with limb fractures undergoing internal fixation in Taishun County People’s Hospital from January 2016 to December 2022 were enrolled. Postoperative infection occurred in 121 cases (infected group) and did not occur in 2 451 cases (uninfected group). Serum levels of PCT, CRP and CD64 were tested at admission and d1, d3, d5 and d7 after operation. Repeated measurement analysis of variance was used to compare the serum levels of PCT, CRP and CD64 at different time points between two groups, the receiver operating characteristic curve (ROC) was used to evaluate the predictive value of each index or in combination for early infection after internal fixation of limbs fractures.Results:The early infection rate after internal fixation was 4.70% (121/2 572). The levels of PCT, CRP and CD64 in the infection group began to rise after operation and decreased on d7; there were significant differences in PCT, CRP and CD64 levels between the two groups on d3, d5 and d7 after operation (PCT: Ftime=678.607, Fintergroup=2 218.323, Finteraction=653.150; CRP: Ftime=392.724, Fintergroup=1 812.502, FInteraction =379.577; CD64: Ftime=373.686, Fintergroup=4 817.438, Finteraction=528.353, all P< 0.001) . The area under the ROC curve of combined detection of PCT, CPR, and CD64 for predicting early infection was 0.856; the sensitivity and specificity of combined detection were 69.2% and 94.7%, respectively. The combined detection of three indicators showed better prediction values than PCT, CRP and CD64 alone ( Z=6.176, 3.838 and 2.431, P<0.01 or <0.05), and also better than combined detection of PCT and CRP ( Z=2.875, P=0.019). Conclusions:The combined detection of CD64, PCT and CRP is of value in prediction of postoperative infection after internal fixation of limb fractures, which is worthy of clinical application.