全膝全髋关节术后假体周围感染病原菌及HBd-3、HBP、ESR、CRP诊断价值  

Etiological characteristics of postoperative periprosthetic infections in total knee total hip arthroplasty patients and diagnostic values of HBd-3,HBP,ESR and CRP

作　　者：俞敏[1] 曹国平[2] 胡君为 李勇 周凤珍[3] YU Min;CAO Guo-ping;HU Jun-wei;LI Yong;ZHOU Feng-zhen(Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine,Hangzhou,Zhejiang 311200,China)

机构地区：[1]杭州市萧山区中医院手术麻醉科,浙江杭州311200 [2]杭州市萧山区中医院关节科,浙江杭州311200 [3]杭州市萧山区中医院手术室,浙江杭州311200

出　　处：《中华医院感染学杂志》2025年第2期219-224,共6页Chinese Journal of Nosocomiology

基　　金：浙江省卫生健康科技计划项目(2023XY166)。

摘　　要：目的探讨全膝全髋关节术后假体周围感染病原菌及人β-防御素-3(HBd-3)、肝素结合蛋白(HBP)、红细胞沉降率(ESR)、C-反应蛋白(CRP)的诊断价值。方法选取2018年8月—2023年8月杭州市萧山区中医院收治的发生假体周围感染全膝全髋关节术后患者60例为感染组,另选同期收治的未发生假体周围感染的全膝全髋关节术后患者102例为非感染组,分析全膝全髋关节术后假体周围感染创面渗液及分泌物病原菌分布及药敏结果,受试者工作特征(ROC)曲线分析血清HBd-3及关节液HBP、ESR、CRP的诊断价值。结果感染组患者共检出菌株62株,其中革兰阳性菌43株占69.35%,以金黄色葡萄球菌21株(33.87%)、表皮葡萄球菌20株(32.26%)居多。金黄色葡萄球菌对青霉素、氨苄西林、苯唑西林、阿莫西林/克拉维酸、红霉素耐药率较高,均>50.00%,表皮葡萄球菌对氨苄西林、苯唑西林、阿莫西林/克拉维酸、红霉素、磺胺甲噁唑/甲氧苄啶耐药率较高,均>50.00%。感染组患者血清HBd-3(2.02±0.48)、关节液HBP(17.15±5.29)ng/ml、ESR(44.59±10.22)mm/h、CRP(81.68±21.67)mg/L水平较高,与非感染组比较有统计学差异(P<0.05)。ROC曲线结果显示,四指标联合检测诊断全膝全髋关节术后假体周围感染的曲线下面积(AUC)值为0.937。结论革兰阳性菌为全膝全髋关节术后假体周围感染患者主要病原菌,不同病原菌的耐药特点不同,血清HBd-3及关节液HBP、ESR、CRP在感染患者中呈高表达,四指标联合检测的诊断价值更高。OBJECTIVE To explore the etiological characteristics of postoperative periprosthetic infections in the total knee total hip arthroplasty patients and analyze the diagnostic values of humanβ-defensin-3(HBd-3),heparin binding protein(HBP),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP).METHODS A total of 60 patients who underwent the total knee total hip arthroplasty and had periprosthetic infections in Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine from Aug.2018 to Aug.2023 were enrolled in the study and were assigned as the infection group,meanwhile,102 total knee total hip arthroplasty patients who did not have postoperative periprosthetic infections were chosen as the non-infection group.The distribution and result of drug susceptibility testing for the pathogens isolated from the periprosthetic wound effusions and secretions were observed.The diagnostic values of serum HBd-3,joint fluid HBP,ESR and CRP were analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Totally 62 strains of pathogens were isolated from the infection group,43(69.35%)of which were gram-positive bacteria;Staphylococcus aureus(21 strains,33.87%)and Staphylococcus epidermidis(20 strains,32.26%)were the predominant species.The drug resistance rates of the S.aureus strains to penicillin,ampicillin,oxacillin,amoxicillin-clavulanic acid and erythromycin were more than 50.00%;the drug resistance rates of the S.epidermidis strains to ampicillin,oxacillin,amoxicillin-clavulanic acid,erythromycin and sulfamethoxazole-trimethoprim were more than 50.00%.The levels of serum HBd-3,joint fluid HBP,ESR and CRP of the infection group were respectively(2.02±0.48),(17.15±5.29)ng/ml,(44.59±10.22)mm/h and(81.68±21.67)mg/L,higher than those of the non-infection group,and there were significant differences between the two groups(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the joint detection of the four indexes was 0.937 in diagnosis of the postoperative periprosthetic infections in

关 键 词：全膝全髋关节术 假体周围感染 病原菌 药敏结果 β-防御素-3 肝素结合蛋白 血沉 C-反应蛋白 

分 类 号：R684[医药卫生—骨科学]