关节液α防御素-1检测在人工关节感染诊断中的应用价值  

Measurement of synovial fluid alpha denfensin- 1 in diagnosis of periprosthetic joint infection

作　　者：洪海峰[1] 李文波[1] 白国昌[1] 黄子达[1] 杨滨[2] 施开 林建华[1] 张文明[1] 

机构地区：[1]福建医科大学附属第一医院关节外科,福州350005 [2]福建医科大学附属第一医院检验科,福州350005

出　　处：《中华关节外科杂志（电子版）》2016年第4期5-10,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：福建省医学创新课题(2014-CX-24)

摘　　要：目的探讨关节液α防御素-1（AD-1）检测在人工关节感染（PJI）诊断中的应用价值。方法选取2013年3月至2015年10月福建省内多家三甲医院骨科45例需行人工关节翻修术患者,男性18例,女性27例,平均年龄（60±14）岁。根据美国肌肉骨骼感染学会（MSIS）诊断标准,纳入标准为全髋及全膝关节置换术后需要进行翻修手术及术后怀疑感染的患者等,排除标准为存在其他身体部位感染病灶等,分为感染组22例,非感染组23例。对45例患者进行关节腔穿刺抽取关节液,采用酶联免疫吸附法（ELISA）检测关节液中AD-1的表达水平。通过受试者工作曲线特征（ROC）曲线计算AD-1、关节液白细胞计数（SF-WBC）、多核比（PMN%）、红细胞沉降率（ESR）、C反应蛋白（CRP）的敏感性及特异性,χ^2检验计算细菌培养的敏感性及特异性。AD-1与各指标间的敏感性及特异性采用χ^2进行比较分析。结果 AD-1诊断PJI的敏感性为86.4%,特异性为91.2%,曲线下面积为0.95。45例患者合并有系统性炎症疾病的患者占31.1%,感染组抽取关节液前有使用过抗生素治疗的患者59%,但AD-1的表达水平并未受到这两项因素的影响。细菌培养、SF-WBC、PMN%、ESR、CRP的敏感性从80%到90.9%,特异性从56.5%到76%。AD-1诊断PJI的敏感性比细菌培养、PMN%、ESR、CRP高,比SF-WBC低;而AD-1诊断PJI的特异性高于各诊断指标。AD-1诊断PJI的特异性与PMN%、ESR、CRP比较差异有统计学意义（P〈0.05）,而与细菌培养、SF-WBC比较差异无统计学意义（P〉0.05）;AD-1诊断PJI的敏感性与细菌培养、SF-WBC、PMN%、ESR、CRP比较差异无统计学意义（P〉0.05）。结论 AD-1诊断PJI具有较高的敏感性及特异性,可作为诊断PJI的一项潜在诊断指标。Objective To evaluate the diagnostic utility of synovial fluid alpha denfensin-1（ AD-1） level in identifying periprosthetic joint infection（ PJI） of the arthroplasty. Methods From March 2013 to October 2015,45 cases needing revison after joint replacemment in the orthopaedic department of firstclass ternary hospitals of Fujian province,were enrolled,including 18 men and 27 women. The mean age was（ 60 ± 14） years. The Musculoskeletal Infection Society（ MSIS） definition of PJI was utilized for the classification of the cases as aseptic or infected ones. Patient-inclusion criteria for this study were as follows： pain at the site of total hip or knee arthroplasty that prompted a clinical evaluation for infection,or revision hip or knee arthroplasty. Infection in other parts of the body lesions were excluded from the study.Twenty-two cases of infection and 23 cases without infection（ as the control group） were enrolled. Synovial fluid aspirates were tested for α-defensin levels by ELISA. Results of the AD-1,synovial fluid cell count（ SF-WBC）,polymorphonuclear percentage（ PMN%）,erythrocyte sedimentation rate（ ESR）,and Creactive protein（ CRP） assay were then assessed by receiver operating characteristic（ ROC） curve analysis to determine the sensitivity and specificity. Chi-square test was used for the sensitivity and the specificity of the bacteria culture. The sensitivity and specificity of the AD-1 assay were compared with the bacteria cultures,SF-WBC,PMN%,ESR and CRP by chi-square test. Results Synovial fluid AD-1 tests demonstrated a sensitivity of 86. 4% and a specificity of 91. 2% for the diagnosis of periprosthetic joint infection. Among the 45 patients,31. 1% accounted for systemic inflammatory diseases and the rate of concurrent antibiotic treatment（ in the 22 infection cases） was 59%. The synovial fluid levels of AD-1 in the PJI patients were unchanged during the antibiotic treatment. The sensitivity and specificity of other tests（ bacteria culture,SF-WBC,PMN%,

关 键 词：人工关节 感染 α防御素 滑液 关节成形术 

分 类 号：R687.4[医药卫生—骨科学]