初次置换术前血清胆红素与假体周围感染的相关研究  

Correlation between serum bilirubin before primary arthroplasty and periprosthetic joint infection

作　　者：陈希跃 付君[1] 徐驰[1] 倪明[1] 李想[1] 柴伟[1] 张国强[1] 郝立波[1] 陈继营[1] CHEN Xi-yue;FU Jun;XU Chi;NI Ming;LI Xiang;CHAI Wei;ZHANG Guo-qiang;HAO Li-bo;CHEN Ji-ying(Department of Orthopaedics,The First Medical Center,General Hospital of PLA,Beijing 100853,China;Department of Orthopaedics,Sanya Peopled Hospital,Sanya 572000,China)

机构地区：[1]解放军总医院第一医学中心骨科,北京100853 [2]海南省三亚市人民医院骨科,海南三亚572000

出　　处：《中国矫形外科杂志》2021年第11期976-979,共4页Orthopedic Journal of China

基　　金：军队医药卫生成果扩试项目(编号:19WKS09)。

摘　　要：[目的]探究初次关节置换术前血清胆红素水平与髋、膝关节置换术后发生关节假体周围感染(periprosthetic joint infection,PJI)的相关性。[方法]回顾性分析2016年1月—2018年12月在解放军总医院第一医学中心骨科行髋、膝关节置换术后翻修患者,共纳39例患者纳入本研究。依据PJI诊断标准,22例为PJI,17例为非PJI组。收集患者一般资料,以及初次关节置换术前血生化、血常规、CRP、IL-6、ESR、D-二聚体等实验室检测指标,比较两组患者间各单项因素,采用ROC曲线分析初次关节置换术前血清总胆红素和直接胆红素诊断PJI的价值。[结果]两组在年龄、性别构成、体质指数、部位、是否吸烟、是否糖尿病、是否冠心病方面的差异均无统计学意义(P>0.05)。但是PJI组的初次置换至翻修手术间隔时间显著短于非PJI组(P<0.05)。初次关节置换术前总胆红素PJI组显著低于非PJI组[(11.00±0.95)μmol/L vs(15.02±1.12)μmol/L,P<0.05],初次关节置换术前直接胆红素PJI组显著低于非PJI组[(3.36±0.28)μmol/L vs(4.87±0.68)μmol/L,P<0.05];两组患者其余的术前化验指标之间差异均无统计学意义(P>0.05)。初次关节置换术前总胆红素预测PJI的AUC=0.729,P=0.015,Cutoff=13.05μmol/L,敏感度=68.18%,特异度=70.59%;初次关节置换术前直接胆红素预测PJI的AUC=0.683,P=0.049,Cutoff=4.00μmol/L,敏感度=77.27%,特异度=58.82%。[结论]初次关节置换术前血清总胆红素和直接胆红素水平PJI患者均显著低于非PJI患者,此两指标有可能用于预测PJI。[Objective]To explore the correlation between serum bilirubin levels before primary arthroplasty and periprosthetic joint infection(PJI)secondary to hip or knee arthroplasty.[Methods]A retrospective study was conducted on 39 patients who underwent the primary and revision total hip or knee arthroplasty at the First Medical Center,General Hospital of PLA from January 2016 to December 2018.According to PJI diagnostic criteria,22 patients were of PJI,while the other 17 patients were of non-PJI.The two groups were compared regarding to general data,as well as laboratory tests before the primary arthroplasty,such as blood biochemical tests,blood routine,CRP,IL-6,ESR,D2 polymer.In addition,the significance of serum total bilirubin and direct bilirubin prior to the primary arthroplasty for predicting PJI was evaluated by using ROC curve.[Results]Although the differences in age,gender composition,body mass index,site,smoking,diabetes,coronary heart disease were not statistically significant between the two groups(P>0.05),the PJI group had significantly shorter interval between the primary and revision arthroplasties than the non-PJI group(P<0.05).In term of laboratory test prior to the primary arthroplasty,the PJI group had significantly lower level of total bilirubin[(11.00±0.95)μmol/L versus(15.02±1.12)μmol/L,P<0.05],and significantly lower level of direct bilirubin[(3.36±0.28)μmol/L versus(4.87±0.68)μmol/L,P<0.05]than the non-PJI group.As results of ROC analysis,the total bilirubin prior to primary arthroplasty for predicting PJI had area under cure(AUC)of 0.729(P<0.05),with cut off(CO)of 13.05μmol/L,sensitivity of 68.18%,and specificity of 70.59%,whereas the direct bilirubin prior to primary arthroplasty for predicting PJI had AUC of 0.683(P<0.05),with CO of 4.00μmol/L,sensitivity of 77.27%,and specificity of 58.82%.[Conclusion]The serum total bilirubin and direct bilirubin levels prior to primary arthroplasty are significantly lower in the patients who will occur PJI than those who will not occur PJI,and t

关 键 词：关节置换术 假体周围感染 胆红素 危险因素 

分 类 号：R687.4[医药卫生—骨科学]