人工关节置换术后假体周围感染诊断方法的比较与评价  

Comparison and estimation of different diagnostic methods in detecting the presence of periprosthetic joint infection

作　　者：唐旭[1] 王启[2] 王辉[2] 王胜锋[3] 钟群杰[1] 李志昌[1] 柯岩[1] 李儒军[1] 李虎[1] 林剑浩[1] 

机构地区：[1]北京大学人民医院关节病诊疗研究中心,100044 [2]北京大学人民医院检验科,100044 [3]北京大学医学部公共卫生学院流行病与卫生统计学系

出　　处：《中华外科杂志》2016年第4期251-257,共7页Chinese Journal of Surgery

摘　　要：目的 比较血液学检查、组织病理学检查、关节液细胞学检查、微生物学检查在人工关节置换术后假体周围感染（PJI）诊断中的价值与特点.方法 回顾性分析2013年7月至2015年3月北京大学人民医院关节病诊疗研究中心收治的52例人工髋关节和膝关节置换术后翻修手术患者的临床资料.男性22例,女性30例.所有患者均行血液学检查[外周血白细胞计数、C反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞介素6（IL-6）、超敏C反应蛋白（Hs-CRP）]、组织病理学检查、关节液细胞学检查和微生物学检查（关节液、组织、关节假体超声裂解液）.根据各检查结果,采用统一的标准进行PJI诊断.分别采用t检验、独立样本中位数检验和x2检验对数据进行统计学分析.采用受试者工作特征曲线衡量各血液学指标对HI的区分度.计算不同检查方法的灵敏度、特异度、阳性预测值、阴性预测值及准确度并进行比较.结果 本研究中PJI患者21例（40.4％）,非感染患者31例（59.6％）.PJI患者血液CRP、ESR、IL-6、Hs-CRP的水平均高于非感染患者（Z=23.084、13.499、5.796、17.045,P值均＜0.05）,其灵敏度分别为90.5％、81.0％、95.0％、90.0％.组织病理学检查和关节液白细胞计数判断PJI的灵敏度分别为55.0％和70.6％,特异度分别为89.7％和85.7％.超声裂解液培养判断PJI的灵敏度（90.0％）高于传统的组织培养（71.4％）与关节液培养（65.0％）（x2=5.333、6.400,P值均＜0.05）.结论 血液学检查中CRP、ESR、IL-6和Hs-CRP具有较好的术前诊断PJI的指导价值;组织病理学检查与关节液白细胞计数判断PJI的特异度较高,有助于排除PJI的诊断;超声裂解液培养较传统的组织、关节液培养在判断PJI方面灵敏度更高.Objective To compare and estimate the diagnostic value and characteristic of different diagnostic methods （blood laboratory test,histological analysis,synovial fluid cytological test and microbiological examination） in detecting the presence of periprosthetic joint infection.Methods Data of 52 patients underwent hip or knee joint revision in Peking University People＇s Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively.For each patient,results of blood laboratory tests （peripheral-blood white blood cell,C-reactive protein （CRP）,erythrocyte sedimentation rate（ESR）,interleukin-6 （IL-6） and high-sensitivity C-reactive protein （Hs-CRP））,histological analysis,synovial fluid white cell count （SWCC）,microbiological examinations （synovial fluid,tissue and prosthetic joint sonication fluid）were collected.Data were analyzed by t-test,independent sample median test or x2 test,respectively.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.Results There were 30 female and 22 male patients.Twenty-one patients（40.4%） were diagnosed as PJI.The levels of CRP,ESR,IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients （Z =23.084,13.499,5.796,17.045,all P 〈 0.05）.The sensitivities of CRP,ESR,IL-6 and Hs-CRP were 90.5%,81.0%,95.0% and 90.0%.The sensitivities of histological analysis and SWCC were 55.0% and 70.6%,while they had high specificity as 89.7% and 85.7%.The sensitivity of sonication fluid culture was 90.0%,which was higher than that of tissue culture（71.4%）and synovial fluid culture（65.0%）（x2 =5.333,6.400,all P 〈 0.05）.Conclusions The tests of CRP,ESR,IL-6 and Hs-CRP have good value in detecting PJI preoperatively.Histological analysis and SWCC have high specificity,which could help to exclude PJI.Sonication fluid culture has a higher sensitivity than tiss

关 键 词：关节成形术 置换 髋 关节成形术 置换 膝 假体周围感染 诊断方法 

分 类 号：R687.4[医药卫生—骨科学]