Li Bin, Chen Fei, Liu Yi, Xu Guokang
Department of Orthopedics II, The First People's Hospital of Fuyang District , Zhejiang, China .
Surg Infect (Larchmt). 2017 Aug/Sep;18(6):702-710. doi: 10.1089/sur.2017.006. Epub 2017 Jul 7.
Total joint arthroplasty (TJA) has been one of the most beneficial interventions for treating patients suffering from joint disorders. However, peri-prosthetic joint infection (PJI) is a serious complication that often accompanies TJA and the diagnosis of PJI is remains difficult. Questions remain regarding whether certain biomarkers can be valuable in the diagnosis of PJI.
We conducted our systematic review by searching PubMed, Embase, Web of Science, the Cochrane Library, and Science Direct with the key words "periprosthetic joint infection," "synovial fluid," and "α-defensin." Studies that provided sufficient data to construct 2 × 2 contingency tables were chosen based on inclusion and exclusion criteria. The quality of included studies was assessed according to the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for the included studies. The summary receiver operating characteristic (SROC) curve and the area under the summary receiver operating characteristic (AUSROC) were used to evaluate the overall diagnostic performance.
Eight studies were included in this systematic review. Among them four articles were included in meta-analysis. A total of 421 participants were studied in the meta-analysis. The pooled sensitivity, specificity, and DOR were 0.98 (95% confidence interval [CI]: 0.94-1.00), 0.97 (95% CI: 0.95-0.99), and 1095.49 (95% CI: 283.68.58-4230.45), respectively. The AUSROC was 0.9949 (standard error [SE] 0.0095).
Synovial fluid α-defensin is a biomarker of high sensitivity and specificity for the diagnosis of PJI.
全关节置换术（TJA）一直是治疗关节疾病患者最有益的干预措施之一。然而，假体周围关节感染（PJI）是TJA常伴随的严重并发症，PJI的诊断仍然困难。关于某些生物标志物在PJI诊断中是否有价值，仍存在疑问。
我们通过在PubMed、Embase、科学网、Cochrane图书馆和Science Direct上搜索关键词“假体周围关节感染”、“滑液”和“α-防御素”进行系统评价。根据纳入和排除标准选择提供足够数据以构建2×2列联表的研究。根据修订后的诊断准确性研究质量评估（QUADAS-2）标准评估纳入研究的质量。计算纳入研究的合并敏感性、特异性和诊断比值比（DOR）。使用汇总受试者工作特征（SROC）曲线和汇总受试者工作特征下面积（AUSROC）评估总体诊断性能。
本系统评价纳入8项研究。其中4篇文章纳入荟萃分析。荟萃分析共研究421名参与者。合并敏感性、特异性和DOR分别为0.98（95%置信区间[CI]：0.94 - 1.00）、0.97（95%CI：0.95 - 0.99）和1095.49（95%CI：283.68.58 - 4230.45）。AUSROC为0.9949（标准误[SE]0.0095）。
滑液α-防御素是诊断PJI的高敏感性和特异性生物标志物。
