Xie Kai, Qu Xinhua, Yan Mengning
Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
J Arthroplasty. 2017 Apr;32(4):1387-1394. doi: 10.1016/j.arth.2016.10.001. Epub 2016 Oct 13.
Current methods to diagnose periprosthetic joint infection (PJI) before revision surgery have limited diagnostic accuracy. This meta-analysis was performed to estimate the accuracy of procalcitonin (PCT) and α-defensin for the diagnosis of PJI.
Articles on the diagnostic value of PCT or α-defensin for PJI diagnosis were searched in the PubMed database. Sensitivity, specificity, diagnostic odds ratio, the area under the curve of summary receiver operating characteristic curves (AUC), the positive likelihood ratio, and the negative likelihood ratio were calculated to evaluate the diagnostic ability of PCT and the α-defensin test for the diagnosis of PJI.
The pooled sensitivities for detecting PJI using PCT and α-defensin were 0.53 (95% confidence interval [CI], 0.24-0.80) and 0.96 (95% CI, 0.85-0.99), respectively. The pooled specificities for detecting PJI using PCT and α-defensin were 0.92 (95% CI, 0.45-0.99) and 0.95 (95% CI, 0.89-0.98), respectively. The pooled diagnostic odds ratios for detecting PJI using PCT and α-defensin were 13 (95% CI, 3-70) and 496 (95% CI, 71-3456), respectively. The pooled AUCs for PCT and α-defensin were 0.76 (95% CI, 0.72-0.80) and 0.99 (95% CI, 0.97-0.99), respectively. The positive likelihood ratio and the negative likelihood ratio of PCT were 6.8 (95% CI, 1.0-48.1) and 0.51 (95% CI, 0.31-0.84), respectively, whereas those of α-defensin were 19.6 (95% CI, 8.2-46.8) and 0.04 (95% CI, 0.01-0.17), respectively.
Synovial fluid α-defensin has a great potential to diagnose PJI.
目前在翻修手术前诊断人工关节周围感染（PJI）的方法，其诊断准确性有限。本荟萃分析旨在评估降钙素原（PCT）和α-防御素对PJI的诊断准确性。
在PubMed数据库中检索有关PCT或α-防御素对PJI诊断价值的文章。计算敏感性、特异性、诊断比值比、汇总受试者工作特征曲线（AUC）下的面积、阳性似然比和阴性似然比，以评估PCT和α-防御素检测对PJI的诊断能力。
使用PCT和α-防御素检测PJI的合并敏感性分别为0.53（95%置信区间[CI]，0.24 - 0.80）和0.96（95%CI，0.85 - 0.99）。使用PCT和α-防御素检测PJI的合并特异性分别为0.92（95%CI，0.45 - 0.99）和0.95（95%CI，0.89 - 0.98）。使用PCT和α-防御素检测PJI的合并诊断比值比分别为13（95%CI，3 - 70）和496（95%CI，71 - 3456）。PCT和α-防御素的合并AUC分别为0.76（95%CI，0.72 - 0.80）和0.99（95%CI，0.97 - 0.99）。PCT的阳性似然比和阴性似然比分别为6.8（95%CI，1.0 - 48.1）和0.51（95%CI，0.31 - 0.84），而α-防御素的阳性似然比和阴性似然比分别为19.6（95%CI，8.2 - 46.8）和0.04（95%CI，0.01 - 0.17）。
滑液α-防御素在诊断PJI方面具有很大潜力。
