白蛋白/球蛋白比值在假体周围关节感染诊断中的应用:系统评价和荟萃分析  

Albumin/globulin ratio in diagnosis of periprosthetic joint infection:a system evaluation and meta-analysis

作　　者：耿启砥 蒋永东 吴宇峰 Geng Qidi;Jiang Yongdong;Wu Yufeng(Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine,Zhongshan 524800,Guangdong Province,China)

机构地区：[1]广州中医药大学附属中山中医院,广东省中山市524800

出　　处：《中国组织工程研究》2024年第36期5892-5898,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家重点研发计划(2021YFC2401300)。

摘　　要：目的:作为全髋关节置换或全膝关节置换后的严重并发症之一,假体周围关节感染一直是关节外科医师所关注的重点。白蛋白与球蛋白比值是诊断假体周围关节感染的一种很有前途的生物标志物。文章旨在探讨白蛋白/球蛋白比值对假体周围关节感染的诊断价值。方法:系统检索PubMed、Embase及Cochrane Library数据库,检索时间为2023-07-29,根据纳排标准来筛选文献,将白蛋白与球蛋白比值的相关诊断试验类文献纳入研究。用QUADAS-2方法对纳入文献质量进行评价,应用双变量混合效应模型合并纳入研究的敏感性、特异性、似然比、诊断优势比,综合受试者工作特征曲线及曲线下面积,以具体评价D-二聚体在诊断假体周围感染时的准确性,用亚组分析的方法探究异质性的来源。结果:纳入8项符合条件的诊断性试验,文献质量均为中上等。合并诊断的敏感度和特异度分别为0.78(95%CI:0.66-0.86)和0.83(95%CI:0.78-0.88),合并后的阳性似然比、阴性似然比分别为4.63(95%CI:3.43-6.22)和0.27(95%CI:0.17-0.42)。合并后的诊断分数和诊断优势比分别为2.85(95%CI:2.23-3.48)和17.35(95%CI:9.29-32.45)。综合受试者工作特征曲线下面积为0.88(95%CI:0.85-0.90)。结论:白蛋白与球蛋白比值对假体周围感染的诊断具有一定的指导意义,但在临床实践中上不具有普适性,运用时仍要结合具体临床。此外,目前对白蛋白与球蛋白比值的阈值、不同采样类型、不同实验室检测方法、不同种族的研究相对较少,今后应开展更多大样本、多中心、科学设计的前瞻性临床试验来验证。OBJECTIVE:As one of the serious complications after total hip arthroplasty or total knee arthroplasty,periprosthetic joint infection has always been the focus of joint surgeons.Albumin/globulin ratio is emerging as a promising biomarker for the diagnosis of periprosthetic joint infection.This study aimed to investigate the diagnostic value of albumin/globulin ratio in diagnosing periprosthetic joint infection.METHODS:A systematic search was conducted in PubMed,Embase,and Cochrane Library databases on July 29,2023.The literature was screened according to the inclusion and exclusion criteria,and the literature related to diagnostic trials of albumin/globulin ratio was included in this study.QUADAS-2 method was used to evaluate the quality of the included articles.Bivariate mixed-effect model was applied to combine the sensitivity,specificity,likelihood ratio,and diagnostic odds ratio of the included articles,and the receiver operating characteristic curve and area under the curve were integrated to specifically evaluate the accuracy of D-dimer in the diagnosis of periprosthetic joint infection.Subgroup analysis was used to explore the sources of heterogeneity.RESULTS:We included eight eligible diagnostic studies,all of which were of medium to high quality.The sensitivity and specificity of the combined diagnosis were 0.78(95%CI:0.66-0.86)and 0.83(95%CI:0.78-0.88),respectively.The combined positive and negative likelihood ratios were 4.63(95%CI:3.43-6.22)and 0.27(95%CI:0.17-0.42),respectively.The combined diagnostic scores and diagnostic odds ratio were 2.85(95%CI:2.23-3.48)and 17.35(95%CI:9.29-32.45),respectively.The area under the summary receiver operating characteristic curve was 0.88(95%CI:0.85-0.90).CONCLUSION:The albumin/globulin ratio is of guiding significance in the diagnosis of periprosthetic joint infection.However,it is not universal in clinical practice,so it should be combined with specific clinical practice.In addition,there are relatively few studies on the threshold of albumin/globulin ratio,differ

关 键 词：白蛋白 球蛋白 白蛋白/球蛋白 髋关节 膝关节 关节置换 假体周围感染 炎症指标 诊断性试验 荟萃分析 

分 类 号：R452[医药卫生—治疗学] R318[医药卫生—临床医学] R605