血清炎症指标在髋关节置换术后慢性假体周围感染中的诊断作用  

Diagnostic role of serum inflammatory indexes in chronic periprosthetic joint infection after total hip arthroplasty

作　　者：王海[1] 宋燕[2] 秦磊磊 王明贵[1] 刘晓冬[1] 饶锐强 尚松 冉广文[1] WANG Hai;SONG Yan;QIN Lei-lei;WANG Ming-gui;LIU Xiao-dong;RAO Rui-qiang;SHANG Song;RAN Guang-wen(First Department of Orthopedics,Fuling Central Hospital of Chongqing,Chogqing 408099,China;Department of Pediatrics,Fuling Central Hospital of Chongqing,Chogqing 408099,China;Department of Orthopedics,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆市涪陵中心医院骨一科,重庆408099 [2]重庆市涪陵中心医院儿科,重庆408099 [3]重庆医科大学附属第一医院骨科,重庆400016

出　　处：《局解手术学杂志》2020年第11期890-895,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：重庆市卫健委面上项目(2015XMSB000210)。

摘　　要：目的探讨血清中C-反应蛋白(CRP)、红细胞沉降率(ESR)及D-二聚体的水平对于诊断髋关节置换(THA)术后慢性假体周围感染(PJI)的临床意义和价值。方法回顾性分析2015年9月至2019年9月重庆市涪陵中心医院收治的47例髋关节翻修手术患者的临床资料。根据美国肌肉与骨骼感染协会(MSIS)制定的关节置换术后PJI诊断标准,将纳入患者分为慢性PJI组(18例)和无菌性松动组(29例)。检测2组患者血清中CRP、ESR及D-二聚体水平,并通过受试者工作特征曲线(ROC)及曲线下面积(AUC)分析CRP、ESR及D-二聚体诊断慢性PJI的截断值,并比较ESR、CRP及D-二聚体联合诊断结果。结果慢性PJI组患者的ESR、CRP和D-二聚体中位数水平高于无菌性松动组(P<0.05)。ROC、AUC以及约登指数统计发现,D-二聚体诊断截断值为1180 ng/L,敏感性及特异性分别为96.97%、69.23%。当D-二聚体>1180 ng/mL、CRP>3.37 mg/L时,对慢性PJI的诊断敏感性为90.90%,特异性为82.10%,诊断准确性可达到84.17%。结论D-二聚体是诊断THA术后慢性PJI更准确的分子标志物,而同时将CRP和D-二聚体联合可显著提高慢性PJI诊断的准确性和特异性。Objective To investigate the clinical significance and value of the levels of serum C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and D-dimer in the diagnosis of chronic periprosthetic joint infection(PJI)after total hip arthroplasty(THA).Methods The clinical data of 47 patients with joint revision surgery admitted to Fuling Central Hospital of Chongqing from September 2015 to September 2019 were retrospectively analyzed.According to the diagnostic criteria of PJI after arthroplasty established by the American Musculoskeletal Infection Society(MSIS),all patients were divided into the chronic PJI group(18 cases)and the aseptic loosing group(29 cases).The serum levels of CRP,ESR and D-dimer between the two groups were tested.And the CRP,ESR and D-dimer were analyzed by the receiver operating characteristic curve(ROC)and area under curve(AUC)to diagnose the cutoff value of chronic PJI and the combined diagnosis results of ESR,CRP and D-dimer were compared.Results The median levels of ESR,CRP and D-dimer in the chronic PJI group were significantly higher than those in the aseptic loosing group(P<0.05).According to the ROC,AUC and Youden index statistics,the cutoff value of D-dimer was 1180 ng/L,and the sensitivity and specificity were 96.97%and 69.23%respectively.When the D-dimer>1180 ng/mL and CRP>3.37 mg/L,the diagnostic sensitivity of chronic PJI was 90.90%,the specificity was 82.10%,and the diagnostic accuracy could reach 84.17%.Conclusion D-dimer is a more accurate molecular marker for diagnosing chronic PJI after THA,and the combination of CRP and D-dimer can significantly improve the accuracy and specificity of chronic PJI diagnosis.

关 键 词：关节置换 假体周围感染 D-二聚体 C-反应蛋白 红细胞沉降率 

分 类 号：R687.4[医药卫生—骨科学]