髋关节置换术后血沉、C反应蛋白、血清淀粉样蛋白A的定量分析及其临床意义

Quantitative analyses of ESR, serum CRP and amyloid A protein levels after artificial hip replacement and their clinical significance

摘要:

目的  检测红细胞沉降率（ESR）、C反应蛋白（CRP）、血清淀粉样蛋白A（SAA）在人工髋关节置换术前后的临床反应参数，探讨3者在人工髋关节置换术后的临床意义。方法  选取人工髋关节置换术患者81例，动态监测术前、术后第1、3、5、7和14天及第1和3个月末血清ESR、CRP、SAA的浓度变化。结果  所有患者术后CRP、SAA值均升高，3 d达峰值，平均浓度分别为（125.35±40.43）和（284.54±87.11）mg/L，1个月后回落至正常水平。ESR第7天时达最大值，平均浓度为（68.41±27.51）mm/h，3个月末回落至正常水平。ESR、CRP、SAA术后呈峰状改变，相对ESR而言，CRP、SAA高峰出现早，回落周期短，稳定性好。结论  血清ESR、CRP及SAA水平的变化反映人工髋关节术后炎症反应严重程度。与ESR比较，CRP、SAA具有敏感性、准确性高的优点，联合3者的临床反应参数对早期髋关节置换术后感染判断具有一定的临床意义。

Abstract:

Objective To investigate the clinical significance of erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and serum amyloid A protein (SAA) levels in patients receiving artificial hip replacement. Methods Eighty-one patients who underwent artificial hip replacement were enrolled. ESR, serum CRP and SAA levels were measured before and on day 1, 3, 5, 7 and 14 and at month 1 and 3 after ope-ration. Results Serum CRP and SAA levels were elevated in all the patients after surgery, peaked on day 3  after operation [average concentration (125.35 ± 40.43) mg/L and (284.54 ± 87.11) mg/L, respectively], and returned to normal level 1 month later. ESR was the highest on day 7 after operation [ (68.41 ± 27.51) mm/h], and returned to normal level 3 months later. Albeit all showing peaking features, the peak  levels of serum CRP and SAA occurred and abated earlier compared with that of ESR, which demonstrated better stability. Conclusions Changes in serum levels of ESR, CRP and SAA reflect the degrees of post-operative inflammation in patients undergoing hip replacement. Compared with ESR level, the levels of CRP and SAA have higher sensitivity and accuracy. Prognostication of early infection after hip replacement based on a combination of these three parameters is of certain clinical significance.