二硫苏糖醇对假体周围感染细菌检出的影响  

Effect of dithiothreitol on bacteria detection in chronic periprosthetic joint infection

作　　者：黄金承 高宗炎[1] 郑文迪 强硕[1] 段润山 刘云可 董永辉 陈骁[1] 代志鹏[1] 郑稼[1] 金毅[1] HUANG Jin-cheng;GAO Zong-yan;ZHENG Wen-di;QIANG Shuo;DUAN Run-shan;LIU Yun-ke;DONG Yong-hui;CHEN Xiao;DAI Zhi-peng;ZHENG Jia;JIN Yi(People’s Hospital of Henan Province,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,河南郑州450003

出　　处：《中国矫形外科杂志》2022年第21期1982-1986,共5页Orthopedic Journal of China

基　　金：河南省科技攻关项目(编号:202102310113);国家自然科学基金青年基金项目(编号:82002840,82002300)。

摘　　要：[目的]探讨二硫苏糖醇(dithiothreitol,DTT)是否可提高关节置换术后假体周围感染(prosthetic joint infection,PJI)患者病原微生物的检出率。[方法]2020年3月1日—2021年10月30日本科收治的46例慢性PJI患者纳入此前瞻性研究。清创术取出病变组织分为3份,1份直接进行细菌培养(直接组),1份用生理盐水浸泡滑膜15 min,用浸泡液行细菌培养(盐水组),另1份使用1 mg/ml浓度的DTT液体浸泡滑膜15 min后,用浸泡液行细菌培养(DTT组)。比较三种培养结果。[结果]总体检出率由高至低依次为:DTT组32/46(69.57%),直接组20/46(43.38%),盐水组17/46(36.96%),差异有统计学意义(P<0.05);DTT组病原微生物检出率显著高于直接组(P=0.011)及盐水组(P=0.001),而直接组与盐水组病原微生物检出率的差异无统计学意义(P=0.529)。46例的138份送检标本共检出69株细菌,3种标本处理各主要菌种检出率的差异均无统计学意义(P>0.05)。46例中,术前使用抗生素治疗的28例患者检出率DTT组为16/28(57.14%),直接组10/28(35.71%),盐水组8/28(28.57%),差异无统计学意义(P=0.079)。术前未使用抗生素的18例检出率为DTT组16/18(88.89%),直接组10/18(55.56%),盐水组9/18(50.00%),差异有统计学意义(P<0.05)。两两比较发现DTT组检出率显著高于盐水组(P=0.014),但与直接组检出率相比差异不具有统计学意义。[结论]使用DTT浸泡病变组织可提高PJI患者病原微生物的检出阳性率。[Objective]To investigate whether dithiothreitol(DTT)can improve the detection rate of pathogenic microorganisms in periprosthetic joint infection(PJI)secondary to joint replacement.[Methods]A prospective study was conducted on 46 patients who admitted to our department from March 2020 to October 2021 for chronic PJI.The tissue samples harvested from debridement were divided into 3 parts.One part was directly cultured for bacteria(direct group),the other part was soaked with normal saline for 15 minutes and then cultured with soaking solution(saline group),while the last part was soaked with 1mg/mL DTT solution for 15 minutes and then cultured with soaking solution(DTT group).The bacterial culture results were compared among the three groups.[Results]The overall bacterial detection rate ranked up-down was 32/46(69.57%)in DTT group,20/46(43.38%)in direct group and 17/46(36.96%)in saline group,with a statistically significant difference among them(P<0.05).In term of pairwise comparison,the DTT group had significantly higher detection rate than the direct group(P=0.011)and saline group(P=0.001),nevertheless there was no significant difference between direct group and saline group(P=0.529).A total of 69 bacterial strains were detected in 138 samples from 46 patients without significant differences in the detection rate of major bacterial species among the three sample treatments(P>0.05).Among the 46 patients,the detection rate of 28 patients who were treated with antibiotics before surgery was 16/28(57.14%)in the DTT group,10/28(35.71%)in the direct group and 8/28(28.57%)in the saline group,with no statistical significance(P=0.079).However,the detection rate of 18 patients who had no antibiotics before operation was16/18(88.89%)in the DTT group,10/18(55.56%)in the direct group,and 9/18(50.00%)in the saline group,which was statistically significant(P<0.05).Pairwise comparison showed that the detection rate of DTT group was significantly higher than that of saline group(P=0.014),but not significantly different between

关 键 词：慢性关节假体周围感染 二硫苏糖醇 病原微生物 生物膜 

分 类 号：R318[医药卫生—生物医学工程]