【摘要】 目的 分析开放性骨折患者术后血清Toll样受体2(TLR-2)、单核细胞趋化蛋白-1(MCP-1)、白介素-6(IL-6)水平与感染的关系。方法 选取2017年10月—2021年7月湖北省汉川市人民医院骨科诊治的开放性骨折患者248例作为研究对象，根据患者术后是否发生感染分为非感染组170例与感染组78例。比较2组术后不同时间血清TLR-2、MCP-1、IL-6水平，Spearman相关性分析术后血清TLR-2、MCP-1、IL-6水平与感染程度的相关性，采用多因素Logistic回归分析开放性骨折患者术后感染的危险因素，绘制受试者工作特征曲线(ROC)预测各项指标对开放性骨折患者术后感染的诊断价值。结果 感染组手术时间≥3 h,住院时间≥4周，伤口深度≥2 cm,手术部位为下肢、腰髋，Ⅱ类、Ⅲ类手术切口比例显著高于非感染组，差异均有统计学意义(χ~2/P=5.994/0.014、33.188/<0.001、82.687/<0.001、6.491/0.011、15.169/<0.001);感染组术后第3、5、7天血清TLR-2、MCP-1、IL-6水平均高于非感染组(P<0.001),且感染组血清TLR-2、MCP-1、IL-6水平在术后第3、5天呈逐渐升高趋势，在术后第5天达到最高，之后呈下降趋势(P<0.01);Spearman相关性分析显示，开放性骨折术后感染患者术后第5天血清TLR-2、MCP-1、IL-6水平与病情程度呈正相关(r/P=0.627/<0.001、0.631/<0.001、0.612/<0.001)。Logistic回归分析显示，手术时间≥3 h,住院时间≥4周，伤口深度≥2 cm,手术部位为下肢、腰髋，手术切口Ⅱ、Ⅲ类及术后第5天血清TLR-2高、MCP-1高、IL-6高均为开放性骨折患者术后感染独立危险因素[OR(95%CI)=19.920(8.745～45.374)、17.415(7.693～39.441)、37.885(15.874～90.415)、27.833(12.883～60.132)、41.390(19.374～88.426)、38.755(15.273～98.341)、39.103(14.941～102.341)、47.743(17.826～127.869)]。ROC曲线显示，术后第5天血清TLR-2、MCP-1、IL-6水平及三者联合预测开放性骨折患者术后感染的曲线下面积(AUC)分别为0.839、0.831、0.828、0.925,三者联合预测效能高于各自单独预测(Z/P=2.493/0.017、2.741/0.012、3.000/0.007)。结论 开放性骨折术后感染患者术后血清TLR-2、MCP-1、IL-6水平明显升高，临床检测其水平有助于对术后感染早期诊断及病情判断。更多还原

【Abstract】 Objective To analyze the relationship between the levels of serum Toll-like receptor 2(TLR-2), monocyte chemoattractant protein-1(MCP-1), interleukin-6(IL-6) and infection in patients with open fracture after operation.Methods Select 248 patients with open fractures who were diagnosed and treated in the Orthopedics Department of Hanchuan People’s Hospital of Hubei Province from October 2017 to July 2021 as the research object, and divide them into non-infection group(170 cases) and infection group(78 cases) according to whether they have infection after operation. The levels of TLR-2, MCP-1 and IL-6 in serum of the two groups at different time after operation were compared. Spearman correlation analysis was used to analyze the correlation between the levels of TLR-2, MCP-1 and IL-6 in serum after operation and the degree of infection. Multivariate logistic regression analysis was used to analyze the risk factors of postoperative infection in patients with open fracture, and the subject work characteristic curve(ROC) was drawn to predict the diagnostic value of various indicators for postoperative infection in patients with open fracture. Results The proportion of operation time ≥ 3 hours, hospital stay ≥ 4 weeks, wound depth ≥ 2 cm, surgical site of lower limb, waist and hip, type II and type III surgical incision in the infection group was higher than that in the non-infection group(t/P=5.994/0.014, 33.188/<0.001, 82.687/<0.001, 6.491/0.011, 15.169/<0.001). The levels of TLR-2, MCP-1 and IL-6 in the infected group were higher than those in the control group on the 3rd, 5th and 7th day after operation(P<0.001), and the levels of TLR-2, MCP-1 and IL-6 in the infected group increased gradually on the 3rd day after operation, reached the highest level on the 5th day after operation, and then decreased; Spearman correlation analysis showed that the serum levels of TLR-2, MCP-1 and IL-6 were positively correlated with the severity of the disease(r/P=0.627/<0.001, 0.631/<0.001, 0.612/<0.001). Logistic regression analysis showed that the operation time ≥ 3 hours, hospital stay ≥ 4 weeks, wound depth ≥ 2 cm, the operation site of lower limb, waist and hip, surgical incision II and III, and the high serum TLR-2, MCP-1 and IL-6 on the fifth day after operation were independent risk factors for postoperative infection in patients with open fracture [OR(95% CI)=19.920(8.745-45.374), 17.415(7.693-39.441), 37.885(15.874-90.415), 27.833(12.883-60.132) 41.390(19.374-88.426), 38.755(15.273-98.341), 39.103(14.941-102.341), 47.743(17.826-127.869)]. The ROC curve showed that the level of serum TLR-2, MCP-1, IL-6 and the area under the curve(AUC) of the three combined to predict the diagnostic value of postoperative infection in patients with open fractures were 0.839, 0.831, 0.828, and 0.925, respectively. The combined predictive efficiency of the three was higher than that of their individual prediction(Z/P=2.493/0.017, 2.741/0.012, 3.000/0.007).Conclusion The serum levels of TLR-2, MCP-1 and IL-6 were significantly increased in patients with postoperative infection of open fractures. Clinical detection of their levels is helpful for early diagnosis and disease judgment of postoperative infection.更多还原