McCutchan H J, Fisher R C
University of Colorado Health Sciences Center, Department of Orthopaedics, Denver 80262.
Clin Orthop Relat Res. 1990 Aug(257):226-30.
The clinical presentation of 41 adult patients with infectious arthritis has been reviewed with special emphasis on initial synovial fluid leukocytosis. Fifty percent of the patients with culture-proven joint-space infections had synovial fluid leukocyte counts below 28,000/mm3. Comparison of this investigation with previous studies of similar magnitude demonstrates a striking difference in the mean and median synovial fluid white cell counts. The population reviewed had a higher incidence of patients with potentially immunocompromising medical conditions than previous reports. Similarities between this and previous reports include predisposing conditions, the spectrum of pathogens cultured, associated clinical findings on admission, hospital course, and mortality. The data presented here document the magnitude of potential overlap between the synovial fluid leukocytosis in infected joints and in joints afflicted with other forms of inflammatory arthropathy. Three patients populations (malignant neoplasms, steroid use, and intravenous drug abuse) with positive cultures from synovial fluid aspirates but initial synovial fluid white cell counts averaging below 50,000 cells/mm3 were identified. Patients with moderate synovial fluid leukocytosis, especially those potentially immunocompromised, must be considered to have infectious arthritis unless other causes of inflammatory arthropathies are demonstrated.
回顾了41例成年感染性关节炎患者的临床表现，特别强调了初始滑液白细胞增多情况。在经培养证实存在关节腔感染的患者中，50%的患者滑液白细胞计数低于28,000/mm³。将本研究与之前规模类似的研究进行比较，结果显示滑液白细胞计数的均值和中位数存在显著差异。与之前的报告相比，本研究纳入的患者中存在潜在免疫功能低下疾病的发生率更高。本研究与之前报告的相似之处包括易感因素、培养出的病原体种类、入院时的相关临床表现、住院病程及死亡率。本文所呈现的数据表明，感染关节的滑液白细胞增多与患有其他形式炎性关节病的关节之间可能存在重叠。已确定有三类患者群体（恶性肿瘤、使用类固醇及静脉药物滥用）滑液抽吸物培养呈阳性，但初始滑液白细胞计数平均低于50,000个细胞/mm³。滑液白细胞轻度增多的患者，尤其是那些可能存在免疫功能低下的患者，除非能证明存在其他炎性关节病病因，否则必须考虑患有感染性关节炎。
