全膝关节置换术后外周血及关节液感染相关标志物水平变化与细菌培养阴性假体周围感染的相关性  

Correlation between changes of markers associated with infection in peripheral blood and joint fluid and periprosthetic infection with negative bacterial culture after total knee replacement

作　　者：张江礼[1] 刘金辉[1] 潘西庆[1] 刘光源 范虓 ZHANG Jiangli;LIU Jinhui;PAN Xiqing;LIU Guangyuan;FAN Xiao(Department of Joint Surgery,Shijiazhuang Third Hospital,Hebei,Shijiazhuang 050000,China)

机构地区：[1]石家庄市第三医院关节一科,河北050000

出　　处：《中国骨与关节损伤杂志》2023年第8期814-819,共6页Chinese Journal of Bone and Joint Injury

基　　金：石家庄市科学技术研究与发展指导计划(181460613)。

摘　　要：目的探讨全膝关节置换术后外周血及关节液感染相关标志物水平变化与细菌培养阴性的假体周围感染的关系。方法纳入自2019-06—2022-06笔者所在医院诊治的100例全膝关节置换术后假体周围感染作为感染组,以及同期诊治的50例全膝关节置换术后无假体周围感染作为对照组。比较对照组与感染组一般资料;比较感染组细菌培养阴性与细菌培养阳性一般资料及生化指标;Logistic回归分析影响细菌培养阴性假体周围感染的因素,分析C-反应蛋白、红细胞沉降率、α-防御素单独及联合诊断细菌培养阴性假体周围感染的价值。结果检测结果显示感染组细菌培养阴性21例,细菌培养阳性79例;对照组细菌培养阴性50例。术后第2~4天细菌培养阳性组C-反应蛋白、红细胞沉降率、肿瘤坏死因子α、白介素-6水平均高于细菌培养阴性组与对照组(P<0.05),而术后第2~4天细菌培养阳性组α-防御素低于细菌培养阴性组与对照组(P<0.05)。Logistic回归分析结果显示术后第2天C-反应蛋白、红细胞沉降率、α-防御素均是影响细菌培养阴性假体周围感染的危险因素(P<0.05)。术后第2天C-反应蛋白、红细胞沉降率、α-防御素联合检测诊断细菌培养阴性假体周围感染AUC值高于单独检测(P<0.05)。结论动态监测C-反应蛋白、红细胞沉降率、α-防御素水平可作为诊断全膝关节置换术后细菌培养阴性假体周围感染的依据,联合检测指标诊断细菌培养阴性假体周围感染价值较高。Objective To explore the relationship between the changes of markers related to infection in peripheral blood and joint fluid and the negative bacterial culture around prosthesis infection after total knee replacement.Methods One hundred cases of periprosthesis infection after total knee replacement treated in our hospital from June 2019 to June 2022 were included as the infection group,and 50 cases without periprosthesis infection after total knee replacement treated during the same period were included as the control group.The general data of control group and infection group were compared.The general information and biochemical indexes of negative and positive bacterial culture were compared in the infection group.Logistic regression analysis was conducted to analyze the factors affecting bacterial culture negative periprosthetic infection,and to analyze the value of C-reactive protein,erythrocyte sedimentation rate,α-defencin alone and combined in the diagnosis of bacterial culture negative periprosthetic infection.Results The results showed negative bacterial culture in 21 cases and positive bacterial culture in 79 cases in the infection group,while in the control group negative bacterial culture in 50 cases.The levels of C-reactive protein,erythrocyte sedimentation rate,tumor necrosis factorαand interleukin-6 in bacteria culture positive group were higher than those in bacteria culture negative group and control group on the 2nd to 4th day after surgery(P<0.05),whileα-defensin in bacteria culture positive group was lower than that in bacteria culture negative group and control group(P<0.05).Logistic regression analysis showed that C-reactive protein,erythrocyte sedimentation rate andα-defencin were risk factors for infection around negative prosthesis on the second day after surgery(P<0.05).The AUC value of the combined test of C-reactive protein,erythrocyte sedimentation rate andα-defencin in the diagnosis of bacterial culture negative periprosthetic infection on the sec‐ond day after surgery was hi

关 键 词：全膝关节置换术 假体周围感染 细菌培养 关节液 诊断价值 

分 类 号：R687.4[医药卫生—骨科学]