基于MALDI-TOF MS半定量检测关节液钙卫蛋白诊断假体周围感染  

Diagnosis of periprosthetic joint infection based on semi-quantitative detection of synovial fluid calprotectin by MALDI-TOF MS

作　　者：徐影 王驰[2] 马雪婷 刘佳玉 郭浩然 宋佳兴 魏文彬 王成彬 Xu Ying;Wang Chi;Ma Xueting;Liu Jiayu;Guo Haoran;Song Jiaxing;Wei Wenbin;Wang Chengbin(Grade 2020,School of Laboratory Medicine,Weifang Medical College,Weifang 261053,China;Department of Laboratory Medicine,the First Medical Centre,Chinese PLA General Hospital,Beijing 100853,China;Intelligene Biosystems(Qingdao)Co.,Ltd.,Beijing 100083,China)

机构地区：[1]潍坊医学院医学检验学院2020级,潍坊261053 [2]解放军总医院第一医学中心检验科,北京100853 [3]融智生物科技(青岛)有限公司,北京100083

出　　处：《中华检验医学杂志》2023年第4期394-401,共8页Chinese Journal of Laboratory Medicine

基　　金：国家自然科学基金(81871731)。

摘　　要：目的探讨关节液钙卫蛋白诊断假体周围感染(PJI)的价值。方法采用前瞻性研究。选择2021年7月至2022年6月解放军总医院第一医学中心髋、膝关节置换术后疑似PJI的82例患者。根据2018年第2次国际共识会议提出的诊断标准分为感染组(PJI组,39例)和未感染组(43例)。采用基质辅助激光解吸/电离飞行时间质谱(MALDI-TOF MS)对各组患者关节液中钙卫蛋白和内部参考标准(IRS)的水平双盲检测,以目标蛋白峰值/IRS峰值作为结果记录。采用Mann-Whitney U检验比较两组间S100A8和S100A9的浓度,采用受试者工作特征(ROC)曲线分析S100A8和S100A9对PJI的诊断效能。结果钙卫蛋白以S100A8单体和S100A9单体的形式被检测到。PJI组关节液S100A8水平明显高于未感染组[1.57(0.48,4.17)比0.00(0.00,0.05),Z=‒7.221,P<0.001];PJI组关节液S100A9水平也明显高于未感染组[0.74(0.29,1.70)比0.06(0.00,0.10),Z=‒6.255,P<0.001]。S100A8和S100A9诊断PJI的敏感度为97.4%和87.2%,特异度86.0%和88.4%,ROC曲线下面积为0.964(95%CI 0.929~0.998)和0.902(95%CI 0.924~0.996)。结论采用MALDI-TOF MS检测关节液S100A8和S100A9对PJI具有较好的诊断价值。Objective To explore the clinical value of synovial fluid calprotectin for the diagnosis of periprosthetic joint infection(PJI).Methods Based on prospective cohort study design,a total of 82 patients suspected of PJI after hip and knee arthroplasty in the First Medical Center of the PLA General Hospital from July 2021 to June 2022 were selected.Patients were divided into infection group(PJI,n=39)and non-infection group(non-PJI,n=43)according to the diagnostic criteria proposed by the Second International Consensus Conference in 2018.The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS)was used for double-blind detection of calprotectin and internal reference standard(IRS)in synovial fluid of patients.The peaks of target protein and IRS were recorded for further analysis.Mann-Whitney U test was used to compare the concentrations of S100A8 and S100A9 between the two groups,and receiver operating characteristic curve(ROC)was used to analyze the diagnostic efficacy of S100A8 and S100A9 for PJI.Results Calprotectin was detected as monomers S100A8 and S100A9.Synovial fluid S100A8 was significantly higher in the PJI group than that in the non-PJI group[1.57(0.48,4.17)vs 0.00(0.00,0.05),Z=‒7.221,P<0.05].Synovial fluid S100A9 was also significantly higher in the PJI group than that in the non-PJI group[0.74(0.29,1.70)vs 0.06(0.00,0.10),Z=‒6.255,P<0.05].When using S100A8 and S100A9 to diagnose PJI,the sensitivity were 97.4%and 87.2%,the specificity were 86.0%and 88.4%,and the area under the ROC were 0.964(95%CI 0.929-0.998)and 0.902(95%CI 0.924-0.996),respectively.Conclusion The detection of synovial fluid S100A8 and S100A9 by MALDI-TOF MS can make a satisfactory diagnosis for PJI.

关 键 词：感染 白细胞L1抗原复合物 基质辅助激光解吸电离 关节形成术 

分 类 号：R687.4[医药卫生—骨科学] R446.5[医药卫生—外科学]