全膝关节置换术后假体周围感染病原菌及BMP-7、bFGF、HBd-3的预测价值  

Pathogenic bacteria for prosthetic joint infections following total knee arthroplasty and predictive values of BMP-7,bFGF and HBd-3

作　　者：罗庆丰 何民[1] 王文龙[1] 胡伟文 唐金平[1] LUO Qingfeng;HE Min;WANG Wenlong;HE Weiwen;TANG Jinping(Chenzhou Third People's Hospital,Chenzhou,Hunan 423000,China)

机构地区：[1]郴州市第三人民医院骨科,湖南郴州423000

出　　处：《中华医院感染学杂志》2025年第4期539-544,共6页Chinese Journal of Nosocomiology

基　　金：湖南省科技发展计划基金资助项目(2023YX0154);郴州市膝关节疼痛诊疗技术研发中心基金资助项目(2021-34)。

摘　　要：目的 探讨全膝关节置换术后假体周围感染的病原菌及血清骨形态发生蛋白7(BMP-7)、碱性成纤维细胞生长因子(bFGF)、人β-防御素-3(HBd-3)水平,分析各指标对术后假体周围感染的预测价值。方法 选取2019年4月-2024年1月郴州市第三人民医院收治的498例全膝关节置换患者,其中术后发生假体周围感染患者为感染组25例,术后未发生假体周围感染患者为未感染组473例。统计感染组病原菌;比较两组炎症指标[C-反应蛋白(CRP)、血沉(ESR)、白细胞(WBC)计数、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)]、BMP-7、bFGF、HBd-3水平;分析BMP-7、bFGF、HBd-3与常规炎症指标的相关性。采用受试者工作特征(ROC)曲线分析BMP-7、bFGF、HBd-3对全膝关节置换术后假体周围感染的诊断价值。结果 25例感染患者共培养分离病原菌28株,其中革兰阳性菌16株占57.14%,革兰阴性菌11株占39.29%,真菌1株占3.57%。感染组CRP、ESR、WBC计数、PCT、TNF-α分别为(27.55±3.78) mg/L、(53.29±8.35) mm/h、(15.71±3.93)×10^(9)/L、(11.23±3.03) ng/ml、(33.11±5.25)pg/ml高于未感染组(P<0.05)。感染组BMP-7、bFGF分别为(66.21±15.73)pg/ml、(55.36±12.65)pg/ml低于未感染组,HBd-3为(2.03±0.63)高于未感染组(P<0.05)。BMP-7和bFGF分别与CRP、ESR、WBC、PCT、TNF-α水平呈负相关(r-=-0.614、-0.592、-0.606、-0.685、-0.734和-0.718、-0.686、-0.754、-0.709、-0.613,P均<0.05);HBd-3与CRP、ESR、WBC、PCT、TNF-α水平呈正相关(r=0.667、0.595、0.559、0.567、0.737,P均<0.05)。BMP-7、bFGF、HBd-3联合检测诊断全膝关节置换术后假体周围感染的曲线下面积(AUC)高于各项单独检测(P <0.05),敏感度为96.00%,特异度86.05%。结论 全膝关节置换术后假体周围感染患者大多为革兰阳性菌感染,BMP-7、bFGF、HBd-3及常规炎症指标表达异常,且BMP-7、bFGF、HBd-3与常规炎症指标存在相关性,BMP-7、bFGF、HBd-3联合检测有助于诊断全膝关节置换术后假�OBJECTIVE To investigate the pathogens for periprosthetic joint infection(PJI)following total knee ar-throplasty,and to analyze the levels of serum bone morphogenetic protein 7(BMP-7),basic fibroblast growth factor(bFGF)and humanβ-defensin-3(HBd-3)and their predictive values for PJI after surgery.METHODS A to-tal of 498 patients who underwent total knee arthroplasty at the Third People's Hospital of Chenzhou from Apr.2019 to Jan.2024 were selected and classified into the infected group with 25 cases and non-infected group with 473 cases based on the presence or absence of PJI.The pathogenic bacteria in the infection group were assessed.The levels of inflammatory markers[C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),white blood cell(WBC)count,procalcitonin(PCT),tumornecrosisfactor-α(TNF-α)],BMP-7,bFGF andHBd-3 were compared between the two groups.The correlations between BMP-7,bFGF and HBd-3 and conventional in-flammatory markers were analyzed.The receiver operating characteristic(ROC)curve was used to analyze the di-agnostic values of BMP-7,bFGF and HBd-3.RESULTS A total of 28 strains of bacteria were isolated from 25 in-fected patients,of which 16 strains were gram-positive(57.14%),11 strains were gram-negative(39.29%),and lstrain was fungi(3.57%).The levels of CRP,ESR,WBC,PCT and TNF-αin the infected group were(27.55±3.78)mg/L,(53.29±8.35)mm/h,(15.71±3.93)X10^(9)/L,(11.23±3.03)ng/mland(33.11±5.25)pg/ml,respectively,which were higher than those in the non-infected group(P<0.05).BMP-7 and bFGF in the infected group were(66.21±15.73)pg/ml and(55.36±12.65)pg/ml,respectively,whichwerelower than those in the non-infected group,and HBd-3 in the infected group was(2.03±0.63),higher than that in the non-infected group(P<0.05).BMP-7 and bFGF were both negatively correlated with CRP,ESR,WBC,PCT and TNF-α(r=-0.614,-0.592,-0.606,-0.685and-0.734,respectively,for BMP-7,and-0.718,-0.686,-0.754,-0.709 and-0.613,respectively,for bFGF,all P<0.05).HBd-3 was pos-itively correlated with CRP,ESR,WBC,PCT and

关 键 词：全膝关节置换术 假体周围感染 病原菌 骨形态发生蛋白7 碱性成纤维细胞生长因子 人β-防御素-3 受试者工作特征曲线 预测价值 

分 类 号：R619.3[医药卫生—外科学]