Nano-seq宏基因组测序在关节置换术后假体周围感染诊断中的应用价值  

Application value of Nano-seq metagenomic sequencing in diagnosis of periprosthetic infections after arthroplasty

作　　者：邓磊 王少华[2] 李征 杨光亚 于雅丽[2] 侯颖周[2] 李科伟[2] 孙博 DENG Lei;WANG Shaohua;LI Zheng;YANG Guangya;YU Yali;HOU Yingzhou;LI Kewei;SUN Bo(The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,Henan,China;Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China;Tangshan Gongren Hospital,Tangshan 063000,Hebei,China)

机构地区：[1]河南中医药大学第一临床医学院,河南郑州450046 [2]郑州市骨科医院,河南郑州450052 [3]唐山市工人医院,河北唐山063000

出　　处：《中医正骨》2023年第10期7-11,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：河南省医学科技攻关计划项目(LHGJ20210791)。

摘　　要：目的:探讨Nano-seq宏基因组测序在关节置换术后假体周围感染诊断中的应用价值。方法:纳入38例人工关节置换术后因疑似假体周围感染再次住院的患者。患者住院后,抽血测定血清C反应蛋白(C-reactive protein,CRP)含量、血沉(erythrocyte sedimentation rate,ESR)和血浆纤维蛋白原(fibrinogen,FIB)含量等指标,抽取关节液进行病原微生物培养和Nano-seq宏基因组测序。患者出院后,从病历系统中提取患者住院时测定的血清CRP含量、ESR、血浆FIB含量及病原微生物培养检验报告、Nano-seq宏基因组测序检验报告及出院诊断结果。分别根据血清CRP含量、ESR、血浆FIB含量、病原微生物培养检验报告、Nano-seq宏基因组测序检验报告诊断假体周围感染,并以出院诊断结果为金标准,计算上述指标诊断假体周围感染的敏感度、特异度、准确度、阳性预测值、阴性预测值。采用受试者操作特征(receiver operating characteristic,ROC)曲线评价不同指标诊断假体周围感染的应用价值。结果:血清CRP含量诊断假体周围感染的敏感度为90.48%、特异度为41.18%、准确度为68.42%,ESR诊断假体周围感染的敏感度为66.67%、特异度为64.71%、准确度为65.79%,血浆FIB含量诊断假体周围感染的敏感度为66.67%、特异度为70.59%、准确度为68.42%,病原微生物培养诊断假体周围感染的敏感度为61.90%、特异度为94.12%、准确度为76.32%,Nano-seq宏基因组测序诊断假体周围感染的敏感度为95.24%、特异度为82.35%、准确度为89.47%。Nano-seq宏基因组测序诊断假体周围感染的敏感度高于ESR、血浆FIB含量、病原微生物培养(P=0.045,P=0.045,P=0.020),特异度高于血清CRP含量(P=0.032),准确度高于血清CRP含量、ESR、血浆FIB含量(P=0.047,P=0.026,P=0.047)。血清CRP含量、ESR、血浆FIB含量、病原微生物培养、Nano-seq宏基因组测序诊断假体周围感染的ROC曲线下面积分别为0.791(P=0.002)、0.Objective:To explore the application value of Nano-seq metagonomic sequencing in the diagnosis of periprosthetie infections after arthroplasty.Methods;Thirty-eight patients re-hospitalized due to suspected periprosthetie infections after arthroplasty were included in the study.After the hospitalization,the blood and joint fluid samples were drawn from patients.The serum level of C-rcactivc pro-tcin(CRP).erythrocyte sedimentation rate(ESR)and the plasma level of fibrinogen(FIB)were measured,and the pathogenic microorganism detection and Nano-seq metagenomie sequencing were conducted.After hospital discharge,the information including serum level of CRP,ESK,plasma level of FIB,the pathogenic microorganism detection report,the Nano-seq metagenomie sequencing report and the discharge diagnosis was extracted from the electronic medical record system.Periprosthetic infections were diagnosed based on the serum level of CRP,ESR,plasma level of FIR,pathogenic microorganism detection report and Nano-seq metagenomie sequencing report respectively.With the hospital discharge diagnosis as the gold standard,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the above-mentioned indicators in diagnosing periprosthetic infections were calculated.The application value of different indicators in diagnosing periprosthetic infections was evaluated by using the receiver operating characteristic (ROC)rune.Results;The sensitivity,specificity and accuracy of serum CRP level in diagnosing periprosthetic infections were 90.48%,41.18%,ami 68.42%,respectively.The sensitivity,specificity ami accuracy of ESR were 66.67%,64.71%and 65.79%,respectively.The sensitivity.specificity,and accuracy of plasma FIB level were 66.67%,70.59%and 68.42%,respectively.The sensitivity.specificity and accuracy of pathogenic microorganism detection were 61.90%,94.12%,and 76.32%,respectively.The sensitivity,specificity and accuracy of Nano-seq metagenomie sequencing were 95.24%,82.35%and 89.47%,respectively.The Nano-seq m

关 键 词：关节成形术 置换 假体和植入物 感染 C-反应蛋白质 血沉 纤维蛋白原 微生物培养检测 Nano-seq宏基因组测序 

分 类 号：R687.4[医药卫生—骨科学]