系统免疫炎症指数和全身炎性反应指数对诊断关节假体周围感染的价值研究  

Diagnostic significance of system immune inflammation index and systemic inflammation response index in periprosthetic joint infection

作　　者：陈文恒 代志鹏[2] 杨慧[3] Chen Wenheng;Dai Zhipeng;Yang Hui(Department of Orthopedics,Zhumadian Central Hospital,Zhumadian 463000,China;Department of Orthopedics,Henan Provincial People’s Hospital,Zhengzhou 450003,China;Xingtai Medical College Surgical Teaching and Research Section,Xingtai 054000,China)

机构地区：[1]驻马店市中心医院骨科,驻马店463000 [2]河南省人民医院骨科,郑州450003 [3]邢台医学高等专科学校外科教研室,邢台054000

出　　处：《中华实验外科杂志》2023年第8期1630-1633,共4页Chinese Journal of Experimental Surgery

基　　金：国家自然科学基金青年项目(82002300);河南省中青年卫生健康科技创新优秀青年人才培养项目(YXKC2021046)。

摘　　要：目的探讨全身免疫炎症指数(SII)和全身炎性反应指数(SIRI)单独及联合ESR、CRP对关节假体周围感染(PJI)的诊断价值。方法研究2017年4月至2021年4月期间在河南省人民医院行髋、膝关节翻修术的139例患者, 64例纳入PJI组, 75例纳入假体无菌性松动组。收集两组患者ESR、CRP、SII以及SIRI的临床资料信息, 绘制各项指标的受试者工作特征(ROC)曲线, 并根据约登指数确定各指标的最佳截断值, 灵敏度、特异度比较其诊断效能。两组比较采用t检验、Mann-WhitneyU检验。结果 PJI组和假体无菌性松动组患者在性别、年龄方面差异均无统计学意义(P>0.05)。PJI组ESR、CRP、SII、SIRI指标高于无菌性松动组[53.50(35.50, 78.50) mm/h比16.00(7.00, 32.00) mm/h, Z=-7.012, P<0.05;24.91(9.48, 54.75) mg/L比2.00(0.80, 7.80) mg/L, Z=-7.007, P<0.05;681.13(446.94, 1 142.05)比374.98(255.61, 586.70), Z=-4.931, P<0.05;0.95(0.64, 1.78)比0.59(0.44, 1.00), Z=-3.822, P<0.05]。ESR、CRP、SII、SIRI曲线下面积分别为0.846、0.845、0.743、0.688。ESR、CRP、SII、SIRI的最佳截断值分别为32.00 mm/h、14.26 mg/L、444.34、0.60, 灵敏度分别为78.12%、70.31%、76.56%、79.69%, 特异度分别为76.00%、88.00%、62.67%、54.67%。ESR+CRP+SII+SIRI的AUC为0.875, 灵敏度为84.37%, 特异度为78.67%。结论 SII、SIRI联合ESR、CRP可以提高对PJI的诊断价值, 但SII、SIRI单独诊断PJI的价值有限。Objective To evaluate the diagnostic value of system immune inflammation index(SII)and systemic inflammation response index(SIRI)alone and in combination with ESR and CRP for periprosthetic joint infection(PJI)after prosthetic joint replacement.Methods A total of 139 patients who underwent hip and knee revision at Henan Provincial People’s Hospital between April 2017 and April 2021 were studied.There were 64 cases in the PJI group and 75 cases in the aseptic loosening of prosthesis group.The clinical data of blood ESR,CRP,SII and SIRI were collected.The receiver operating characteristic(ROC)curves of each index were plotted,the optimal cut-off value of each index was determined according to the Jorden index,and the sensitivity and specificity were compared for its diagnostic efficacy.The t-test and Mann-Whitney U test were used to compare the two groups.Results There was no statistically significant difference in gender and age between the patients in the PJI and prosthetic aseptic loosening groups(P>0.05).ESR,CRP,SII,and SIRI indexes were higher in the PJI group than in the aseptic loosening group[53.50(35.50,78.50)mm/h vs.16.00(7.00,32.00)mm/h,Z=-7.012,P<0.05,24.91(9.48,54.75)mg/L vs.2.00(0.80,7.80)mg/L,Z=-7.007,P<0.05,681.13(446.94,1142.05)vs.374.98(255.61,586.70),Z=-4.931,P<0.05,0.95(0.64,1.78)vs.0.59(0.44,1.00),Z=-3.822,P<0.05].The areas under the curves of ESR,CRP,SII,and SIRI were 0.846,0.845,0.743,and 0.688,respectively.the optimal cutoff values of ESR,CRP,SII,and SIRI were 32.00 mm/h,14.26 mg/L,444.34,and 0.60,with sensitivities of 78.12%,70.31%,76.56%,and 79.69%,and specificities of 76.00%,88.00%,62.67%,and 54.67%,respectively.The area under curve(AUC)of ESR+CRP+SII+SIRI was 0.875,sensitivity was 84.37%and the specificity was 78.67%.Conclusion SII and SIRI combined with ESR and CRP can improve the diagnostic value of PJI,but SII and SIRI alone have limited value in diagnosing PJI.

关 键 词：关节假体周围感染 全身免疫炎症指数 全身炎性反应指数 诊断 

分 类 号：R684[医药卫生—骨科学]