血清蛋白电泳对TsukayamaⅣ型假体周围感染的诊断意义  

Significance of serum protein electrophoresis in the diagnosis of TsukayamaⅣperi-prosthetic infection

作　　者：路鑫哲 胡明玮 徐浩[1] 项帅 张海宁[1] Lu Xinzhe;Hu Mingwei;Xu Hao;Xiang Shuai;Zhang Haining(Department of Joint Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266035,China)

机构地区：[1]青岛大学附属医院关节外科,青岛266035

出　　处：《中华骨科杂志》2023年第18期1233-1240,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金项目(82002349)。

摘　　要：目的探讨血清蛋白电泳对髋、膝关节置换术后假体周围感染(periprosthetic joint infection,PJI)的诊断价值。方法回顾性分析2013年8月至2019年6月于青岛大学附属医院关节外科因PJI或假体无菌性松动行单侧人工髋、膝关节翻修术的患者171例。根据翻修原因分为:PJI组55例,男29例、女26例,年龄(67.38±9.60)岁,26髋、29膝,均为Tsukayama分型Ⅳ型;无菌性松动(aseptic loosening,AL)组116例,男67例、女49例,年龄(69.69±9.20)岁,97髋、19膝。统计分析两组患者术前C反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、D-二聚体、纤维蛋白原、血清总蛋白、血清白蛋白、血清球蛋白及血清蛋白电泳各条带的比例,以受试者工作特征(receiver operating characteristic,ROC)曲线计算指标的灵敏度和特异度,依据曲线下面积(area under curve,AUC)比较其诊断价值。结果PJI组和AL组年龄、性别、体质指数(body mass index,BMI)的差异均无统计学意义(P>0.05),髋、膝比例的差异有统计学意义(χ^(2)=24.41,P<0.001)。PJI组α1球蛋白条带比例为6.40%(5.30%,8.10%),较AL组的4.20%(3.90%,4.80%)高,差异有统计学意义(H=453.50,P<0.001);PJI组白蛋白条带比例为49.00%(44.00%,52.20%),较AL组的54.35%(51.25%,56.70%)低,差异有统计学意义(H=4954.00,P<0.001)。CRP、ESR、D-二聚体、纤维蛋白原、电泳白蛋白条带和α1球蛋白条带的AUC分别为0.87[95%CI(0.80,0.93)]、0.88[95%CI(0.82,0.94)]、0.67[95%CI(0.58,0.76)]、0.87[95%CI(0.82,0.93)]、0.78[95%CI(0.70,0.85)]和0.87[95%CI(0.81,0.93)]。结论血清蛋白电泳中的白蛋白条带和α1球蛋白条带对PJI具有较高的诊断价值,其中α1球蛋白条带的准确性近似于CRP、ESR和纤维蛋白原。Objective To evaluate the value of serum protein electrophoresis in the diagnosis of periprosthetic joint infection(PJI)after hip and knee arthroplasty.Methods The data of 171 patients who underwent one side hip or knee revision surgery in the affiliated Hospital of Qingdao University from August 2013 to June 2019 were analyzed retrospectively.According to the reasons for revision,55 patients in PJI group,29 males and 26 females,aged 67.38±9.60 years,26 hips and 29 knees,were classified as Tsukayama type IV;Aseptic loosening(AL)group consisted of 116 patients,67 males and 49 females,aged 69.69±9.20 years,97 hips and 19 knees.The ratios of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),D-dimer,fibrinogen,serum total protein,serum albumin,serum globulin and serum protein electrophoresis bands in the two groups were statistically analyzed.The sensitivity and specificity of each index were calculated according to the receiver operating characteristic(ROC)curve,and the diagnostic value was compared according to the area under the curve(AUC).Results There was no significant difference in age,sex or body mass index(BMI)between PJI group and AL group(P>0.05),but there was significant difference in joint type with 26 hips and 29 knees in PJI group,97 hips and 19 knees in AL group(χ^(2)=24.41,P<0.001).The proportion ofα1 globulin band was 6.40%(5.30%,8.10%)in PJI group,which increased significantly compared to 4.20%(3.90%,4.80%)in AL group(H=453.50,P<0.001).Albumin band was 49.00%(44.00%,52.20%)in PJI group,which decreased significantly compared to 54.35%(51.25%,56.70%)in AL group(H=4954.00,P<0.001).The AUC of CRP,ESR,D-dimer,fibrinogen,albumin band andα1 globulin band were 0.87[95%CI(0.80,0.93)],0.88[95%CI(0.82,0.94)],0.67[95%CI(0.58,0.76)],0.87[95%CI(0.82,0.93)],0.78[95%CI(0.70,0.85)]and 0.87[95%CI(0.81,0.93)],respectively.Conclusion Albumin bands andα1 globulin bands in serum protein electrophoresis had high diagnostic value for PJI,and the accuracy ofαl globulin bands was as good as that of routine

关 键 词：假体相关感染 临床实验室技术 蛋白电泳法 甲种球蛋白类 

分 类 号：R687.4[医药卫生—骨科学]