滑液中PRTN3和MNDA诊断关节假体周围感染的效能:与α-防御素的比较  

Performance of Synovial Fluid PRTN3 and MNDA for Diagnosing Periprosthetic Joint Infection:Comparison with the Use ofα⁃defensin

作　　者：刘铮 安浩铭 唐云皓 谷旺 高志森[1,3] 李睿 柴伟[1,3] Liu Zheng;An Haoming;Tang Yunhao;Gu Wang;Gao Zhisen;Li Rui;Chai Wei(Senior Department of Orthopedics,the Fourth Medical Center of People's Liberation Army General Hospital,Beijing 100048,China;Chinese People's Liberation Army Medical School,Beijing 100853,China;National Clinical Research Center for Orthopedics,Sports Medicine&Rehabilitation,Beijing 100853,China;School of Medicine,Nankai University,Tianjin 300071,China)

机构地区：[1]解放军总医院第四医学中心骨科医学部,北京100048 [2]解放军医学院,北京100853 [3]国家骨科与运动康复临床医学研究中心,北京100853 [4]南开大学,天津300071

出　　处：《骨科》2024年第3期224-228,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(U22A20355)。

摘　　要：目的检测关节滑液中标志物蛋白酶3(proteinase 3,PRTN3)和髓样细胞核分化抗原(my-eloid nuclear differentiation antigen,MNDA)在关节假体周围感染(periprosthetic joint infection,PJI)诊断中的临床效能,并与传统标志物α-defensin进行比较。方法回顾性收集连续65例因怀疑PJI而进行髋膝关节诊断性穿刺病人的关节滑液标本。基于2014年肌肉骨骼感染协会(Musculoskeletal Infection Soci-ety,MSIS)标准,将29例纳入PJI组,36例纳入非PJI组。随后使用商用ELISA试剂盒检测关节滑液中的三种标志物水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价所研究生物标志物的诊断效能,并计算其各自的敏感度、特异度与截断值。结果PJI组菌培养结果以葡萄球菌为主,占比31%,培养阴性病人占比34.5%。ROC分析结果显示,PRTN3的曲线下面积(area under the curve,AUC)最大,为0.984(95%CI,0.961~1.000),其次是α-defensin,AUC为0.944(95%CI,0.888~1.000),最后为MNDA,AUC为0.849(95%CI,0.755~0.943)。PRTN3的最佳截断值为318.000(ng/mL),敏感度为0.931,特异度为0.972。α-defensin的最佳截断值为7.150(μg/mL),敏感度为0.931,特异度为0.861。MNDA的最佳截断值为4.318(ng/mL),敏感度为0.862,特异度为0.722。结论PRTN3和MNDA都是PJI的优秀生物标志物。PRTN3的诊断性能最好,甚至略优于α-defensin。Objective To verify the reliability of proteinase 3(PRTN3)and myeloid nuclear differentiation antigen(MNDA)for diagnosing periprosthetic joint infection(PJI)via ELISA,and to compare with traditional biomarkersα-defensin.Methods A total of 65 consecutive specimens from patients with suspected PJI were included in this study.Based on the 2014 Musculoskeletal Infection Society(MSIS)criteria,29 patients were included in the PJI group and 36 in the non-PJI group.Commercial ELISA kits were used to detect the biomarker levels in synovial fluid.The sensitivity and specificity of the biomarkers were analyzed,and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic performance of the investigated biomarkers.Results The PJI group was dominated by staphylococcus,accounting for 31%,and the negative culture patients accounted for 34.5%.PRTN3 had the highest area under the curve at 0.984(95%CI,0.961-1.000),followed byα-defensin and MNDA,with AUC of 0.944(95%CI,0.888-1.000)and 0.849(95%CI,0.755-0.943),respectively.The cutoff value of PRTN3 was 318.000 ng/mL,and its sensitivity and specificity were 0.931 and 0.972,respectively.The cutoff value ofα-defensin was 7.150μg/mL,and its sensitivity and specificity were 0.931 and 0.861,respectively.The cutoff value of MNDA was 4.318 ng/mL,and its sensitivity and specificity were 0.862 and 0.722,respectively.Conclusion Both PRTN3 and MNDA are excellent biomarkers for PJI.The PRTN3 has the best performance even slightly better than that ofα-defensin.

关 键 词：关节假体周围感染 生物标记物 蛋白酶3 髓样细胞核分化抗原 

分 类 号：R684[医药卫生—骨科学]