Diagnosis Value Of C-reactive Protein,Erythrocyte Sedimentation Rate,Procalcitonin White Blood Cell And Neutrophil For Suppurative Spondylitis

Objective:To investigate the clinical value of C-reactive protein,erythrocyte sedimentation rate,procalcitonin,white blood cell and neutrophil for the diagnosis of suppurative spondylitis.Methods:The C-reactive protein,erythrocyte sedimentation rate,procalcitonin,total number of white blood cell and total number of neutrophil in 36 cases of suppurative spondylitis(in group A),in 49 cases of spinal tuberculosis(in group B),in 41 cases of osteoporotic vertebral compression fractures(in group C)and the other 60 cases of healthy people(in group D)from June 2014-December 2017 in the Affiliated Hospital of Southwest Medical University and the clinical dates were collected and analyzed,the levels,sensitivity,specificity were compared between the four groups.According to the blood culture results,the suppurative spondylitis group was divided into blood culture positive group(in group A1)and blood culture negative group(in group A2).The differences in C-reactive protein,erythrocyte sedimentation rate,procalcitonin,total number of white blood cell and total number of neutrophil between the two groups were compared;The ROC curves for the diagnosis of suppurative spondylitis were compared for each inflammatory marker,and the area under the ROC curve for each inflammatory marker was compared,The point which the sum of sensitivity and specificity was maximized was taken as the cut-off point,and the optimal cut-off point for the diagnosis of suppurative spondylitis was obtained for each index,and the corresponding sensitivity and specificity were calculated.Logistic multiple regression analysis was used to compare the correlation between WBC,NEU,ESR,CRP,PCT and suppurative spondylitis.Results:The average number of C-reactive protein in groups A,B,C,and D was74.84±50.38 mg/L,48.69±53.93 mg/L,9.02±12.16 mg/L,and 6.14±3.00 mg/L,respectively.The mean CRP in group A was highly significant than it in group B,C and D(P<0.05);The average number of ESR in groups A,B,C,and D was94.56±26.45 mm/h,65.57±29.65 mm/h,and 37.49±22.01 mm/h,10.73±4.15mm/h,respectively.The mean ESR in group A was highly significant than it in group B,C and D(P<0.05);The average number of PCT in group A,B,C,D was 0.42±0.21 ng/ml,0.20± 0.26 ng/ml,0.03±0.02 ng/ml,0.03±0.01 ng/ml,respectively.The mean PCT in group A was highly significant than it in group B,C and D(P<0.05);The average number of CRP in the A1 and A2 groups was97.60±46.05 mg/L,46.39±41.02 mg/L,respectively.The mean CRP in group A1 was highly significant than it in group A2(P<0.05);The average number of ESR in A1 and A2 groups was 101.40±22.89 mm/h and 86.00±28.77 mm/h,respectively.And the mean ESR in group A1 was highly significant than it in group A2(P<0.05);The average number of PCT in the A1 and A2 groups were0.50±0.24 ng/ml and 0.33±0.09 ng/ml,respectively,The mean PCT in group A1 was highly significant than it in group A2(P<0.05);The positive rates of CRP in the diagnosis of suppurative spondylitis,spinal tuberculosis,and OVCF were97.22%,73.47%,and 26.83%,respectively.The positive rates of ESR in the diagnosis of suppurative spondylitis,spinal tuberculosis,and OVCF were94.44%,83.67%,and 36.59%,respectively.The positive rates of PCT in the diagnosis of suppurative spondylitis,spinal tuberculosis,and OVCF were 100%,79.59%,and 7.32%,respectively;The sensitivity of PCT in the diagnosis of pyogenic spondylitis was 100%,the specificity was 72.0%,and the area under the ROC curve was 0.96.The sensitivity of ESR in the diagnosis of suppurative spondylitis was 94.4%,the specificity was 55.2%,and the ROC curve was 0.91.The sensitivity of CRP in the diagnosis of pyogenic spondylitis was 97.2%,the specificity was 67.3%,and the area under the ROC curve was 0.87.The sensitivity,specificity,and area under the ROC curve of PCT were higher than those of other inflammatory markers and the difference was statistically significant(P<0.05).When the optimal cut-off point of PCT was 0.20 ng/ml,the sensitivity and specificity of the diagnosis of pyogenic spondylitis were100% and 94.7%.When the optimal cut-point of ESR was 67.5mm/h,the sensitivity and specificity of diagnosis of purulent spondylitis were 86.1% and86.0%.When the optimal cutoff point of CRP was 11.12mg/L,the sensitivity and specificity of diagnosis of purulent spondylitis were 97.2% and 69.3%.Logistic multiple regression analysis showed that there was a positive correlation between ESR,PCT and pyogenic spondylitis,the PCT OR value was 1.853,and 95% confidence interval(CI)was 1.190 to 2.886,the ESR OR value was 1.040,and 95% confidence interval(CI)was 1.021 to 1.059.Conclusions: The C-reactive protein,erythrocyte sedimentation rate and procalcitonin have certain clinical value in the diagnosis of suppurative spondylitis.At the same time,they have the same clinical value in the differential diagnosis of pyogenic spondylitis and spinal tuberculosis and vertebral osteoporotic compression fractures.The clinical value of PCT for the diagnosis and differential diagnosis of suppurative spondylitis was significantly higher than ESR and CRP,while the traditional inflammatory indicators WBC,NEU in the diagnosis of spondylitis and differential diagnosis of spinal tuberculosis,osteoporosis vertebral compression fractures has no special feature.In patients with positive blood cultures of pyogenic spondylitis,the PCT and CRP have greater diagnostic value.