血清学指标对慢性假体周围感染诊断价值的研究  

Diagnostic value of serological indicators in chronic periprosthetic joint infection

作　　者：努尔艾力江·玉山 吾湖孜·吾拉木[1,2,3] 郭晓斌 李亦丞 张晓岗 曹力[1,2,3] Nuerailijiang·Yushan;Wuhuzi·Wulamu;GUO Xiaobin;LI Yicheng;ZHANG Xiaogang;CAO Li(Department of Joint Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Key Laboratory of High Incidence Disease Research in Xinjiang,Ministry of Education(Xinjiang Medical University),Urumqi 830054,China;Xinjiang Clinical Research Center for Orthopaedics,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院关节外科,乌鲁木齐830054 [2]新疆地区高发疾病研究教育部重点实验室(新疆医科大学),乌鲁木齐830054 [3]新疆骨科疾病临床医学研究中心,乌鲁木齐830054

出　　处：《中华骨与关节外科杂志》2024年第11期983-988,共6页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金地区科学基金(82160421);新疆维吾尔自治区科学技术厅科技创新团队项目(2023TSYCTD0014)。

摘　　要：目的:探讨血清学指标在慢性假体周围感染(PJI)中的诊断价值。方法:回顾性分析2012年1月至2018年12月新疆医科大学第一附属医院接受人工髋、膝关节翻修手术的患者,共纳入441例,因慢性PJI行翻修术的204例作为PJI翻修组,其余因非PJI的无菌性假体松动、磨损和不稳定行翻修术的237例作为无菌性翻修组。绘制受试者操作特征(ROC)曲线,以评价C反应蛋白(CRP)、红细胞沉降率(ESR)、CRP+ESR、CRP-白蛋白比值、CRP-球蛋白比值对慢性PJI的诊断价值,分析曲线下面积(AUC),计算敏感度和特异度,使用约登指数确定最佳截断值。结果:PJI翻修组患者CRP、ESR、CRP+ESR、CRP-白蛋白比值、CRP-球蛋白比值分别为17.85(8.50,30.62)mg/L、47.50(28.50,60.00)mm/h、66.75(43.00,90.02)、0.47(0.21,0.90)、0.56(0.27,0.91),均高于无菌性翻修组患者的3.60(2.00,6.43)mg/L、20.00(11.50,30.00)mm/h、22.90(15.00,36.40)、0.08(0.04,0.16)、0.13(0.07,0.23),差异均有统计学意义(P均<0.001)。CRP、ESR、CRP+ESR、CRP-白蛋白比值、CRP-球蛋白比值诊断慢性PJI的AUC分别为0.827(95%CI:0.786~0.868)、0.808(95%CI:0.768~0.848)、0.838(95%CI:0.800~0.876)、0.828(95%CI:0.787~0.869)、0.810(95%CI:0.767~0.852);最佳截断值分别为10.05 mg/L、31.50 mm/h、42.46、0.25、0.29;敏感度分别为72.5%、72.5%、76.0%、73.5%、75.0%;特异度分别为86.5%、76.8%、81.0%、86.5%、81.4%。结论:CRP-白蛋白比值诊断慢性PJI的价值优于CRP或ESR。CRP-球蛋白比值诊断慢性PJI的价值亚于CRP或ESR,但敏感度较高。CRP+ESR诊断慢性PJI的价值最优,联合CRP+ESR与CRP-白蛋白比值、CRP-球蛋白比值可提高诊断敏感度及特异度。Objective:To evaluate the diagnostic value of serological indicators in chronic periprosthetic joint infection(PJI).Methods:A retrospective analysis was conducted on patients who underwent hip and knee revision arthroplasty at the First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2018.A total of 441 cases were included:204 patients with chronic PJI(PJI revision group) and 237 patients with aseptic prosthesis loosening,wear,or instability(aseptic revision group).The receiver operating characteristic(ROC) curve was used to calculate the sensitivity and specificity of each indicator,and the area under the curve(AUC) was analyzed to evaluate the diagnostic value of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),CRP+ESR,CRP/albumin ratio,and CRP/globulin ratio for chronic PJI.The Youden index was used to determine the optimal cutoff values for diagnosis.Results:The CRP level,ESR,CRP+ESR,CRP/albumin ratio,and CRP/globulin ratio in the PJI revision group were 17.85(8.50,30.62) mg/L,47.50(28.50,60.00) mm/h,66.75(43.00,90.02),0.47(0.21,0.90) and 0.56(0.27,0.91),respectively,which were significantly greater than those in the aseptic revision group [3.60(2.00,6.43) mg/L,20.00(11.50,30.00) mm/h,22.90(15.00,36.40),0.08(0.04,0.16),0.13(0.07,0.23),respectively](all P<0.001).The AUCs for diagnosing chronic PJI were 0.827(95%CI:0.786-0.868) for CRP,0.808(95%CI:0.768-0.848) for ESR,0.838(95%CI:0.800-0.876) for CRP+ESR,0.828(95%CI:0.787-0.869) for CRP/albumin ratio,and 0.810(95%CI:0.767-0.852) for CRP/globulin ratio.The optimal cutoff values were as follows:CRP,10.05 mg/L;ESR,31.5 mm/h;CRP+ESR,42.46;CRP/albumin ratio,0.25,and CRP/globulin ratio,0.29.The corresponding sensitivities were 72.5%,72.5%,76%,73.5% and 75%,and the specificities were 86.5%,76.8%,81%,86.5% and 81.4%,respectively.Conclusions:The CRP/albumin ratio has superior clinical value in diagnosing chronic PJI compared to CRP or ESR alone.The CRP/globulin ratio also has high sensitivity but inferior diagnostic value.CRP+

关 键 词：C反应蛋白 红细胞沉降率 白蛋白 球蛋白 假体周围感染 生物标志物 

分 类 号：R619[医药卫生—外科学]