摘要
目的探讨纤维蛋白原和D-二聚体对髋、膝关节置换术后(TJA)假体周围感染(PJI)的诊断价值。方法回顾性分析自2013年8月至2019年6月在青岛大学附属医院关节外科进行人工髋、膝关节翻修术的175例患者资料。其中59例被诊断为PJI(PJI组)(膝31例,髋28例),男33例,女26例;年龄(67.4±11.7)岁;体重指数(BMI)为(26.1±3.6)kg/m2。116例被诊断为无菌性松动(AL)(AL组)(膝19例,髋97例),男67例,女49例;年龄(70.3±8.9)岁;BMI为(25.0±3.6)kg/m^(2)。统计分析两组患者血浆C反应蛋白(CRP)、红细胞沉降率(ESR)、纤维蛋白原和D-二聚体的水平,以受试者工作特征(ROC)曲线计算每个指标的灵敏度与特异度,并依据曲线下面积(AUC)比较其诊断价值。结果PJI组和AL组患者在性别、年龄、BMI等方面差异均无统计学意义(P>0.05),但在关节类型方面差异有统计学意义(P<0.05)。与AL组比较,PJI组CRP、ESR、纤维蛋白原和D-二聚体均显著升高,差异有统计学意义(P<0.05)。CRP、ESR、纤维蛋白原和D-二聚体的曲线下面积分别为0.830、0.850、0.848、0.664。根据约登指数,CRP、ESR、纤维蛋白原和D-二聚体的最佳临界值分别为8.06 mg/L、17.60 mm/h、3.73 g/L、685.00 ng/mL,敏感度分别为79.2%、85.4%、81.3%、64.6%,特异性分别为85.7%、76.2%、79.8%、61.9%。结论纤维蛋白原对PJI有较高的诊断价值,其准确性与CRP和ESR相近,但D-二聚体的诊断价值有限。
Objective To evaluate the diagnostic values of serum fibrinogen and D-dimer for periprosthetic joint infection(PJI).Methods The medical records were retrospectively analyzed of the 175 patients who had undergone hip or knee revisions at Department of Joint Surgery,Affiliated Hospital to Qingdao University from August 2013 to June 2019.Of them,59 were diagnosed as PJI(31 knees and 28 hips),including 33 males and 26 females with an age of(67.4±11.7)years and a body mass index(BMI)of(26.1±3.6)kg/m^(2) while 116 as aseptic loosening(AL)(19 knees and 97 hips),including 67 males and 49 females with an age of(70.3±8.9)years and a BMI of(25.0±3.6)kg/m2.The plasma levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),fibrinogen and D-dimer in the 2 groups were recorded and analyzed.The receiver operating characteristic curve(ROC)was used to calculate the sensitivity and specificity of each indicator;the diagnostic value for each indicator was calculated according to the area under the curve(AUC).Results There was no significant difference between the PJI and AL groups in gender,age or BMI(P>0.05),but there was a significant difference in the joint type(P<0.05).Compared with the AL group,the PJI group had significantly higher levels of CRP,ESR,fibrinogen and D-dimer(P<0.05).The AUCs for CRP,ESR,fibrinogen and D-dimer were 0.830,0.850,0.848 and 0.664,respectively.By the Youden index,the optimal predictive cutoffs for CRP,ESR,fibrinogen and D-dimer were 8.06 mg/L,17.60 mm/h,3.73 g/L and 685.00 ng/mL,giving sensitivities of 79.2%,85.4%,81.3%and 64.6%and specificities of 85.7%,76.2%,79.8%and 61.9%.Conclusions The diagnostic value of serum fibrinogen may be high for PJI,similar to that of CRP or ESR.However,D-dimer may be of limited value for diagnosis of PJI.
作者
商广前
项帅
黄辉
季丰
张海宁
王英振
徐浩
Shang Guangqian;Xiang Shuai;Huang Hui;Ji Feng;Zhang Haining;Wang Yingzhen;Xu Hao(Department of Joint Surgery,Affiliated Hospital to Qingdao University,Qingdao 266000,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2021年第5期383-388,共6页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金青年项目(82002349)。
