Mitchell Duran, Perez Jose, Grau Luis, Summers Spencer, Rosas Samuel, Ong Alvin, Schneiderbauer Michaela M, Hernandez Victor H
Department of Orthopaedics, University of Miami, Miami, FL.
Am J Orthop (Belle Mead NJ). 2017 Jul/Aug;46(4):190-198.
Prosthetic joint infection (PJI) may be underreported because of difficulty in making a diagnosis, especially in infections with low-virulence organisms. Reports of PJI cases misdiagnosed as aseptic loosening suggest that current screening and diagnostic tools are not sensitive enough to detect all infections and that PJI likely is underdiagnosed. We reviewed the literature on recently developed novel synovial biomarkers and polymerase chain reaction (PCR) technologies, of which several have proved promising as highly sensitive and specific tools for detecting PJI. We followed the recommendations of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Of 90 papers screened by title or abstract and then by full text, 15 met our inclusion criteria. Sensitivities reported in the included studies ranged from 63% to 100% for α-defensin, from 46.8% to 90.9% for interleukin 6, from 28.6% to 100% for leukocyte esterase, and from 67.10% to 95.7% for PCR. Specificities ranged from 95% to 100% for α-defensin, from 85.7% to 97.6% for interleukin 6, from 63.6% to 96.5% for leukocyte esterase, and from 12.3% to 97.8% for PCR. α-Defensin is a highly sensitive and specific screening tool that may help improve the accuracy of PJI detection, particularly in low-grade infections.
由于诊断困难，尤其是对于低毒力微生物感染，人工关节感染（PJI）可能未得到充分报告。将PJI病例误诊为无菌性松动的报告表明，目前的筛查和诊断工具不够灵敏，无法检测出所有感染，PJI很可能未得到充分诊断。我们回顾了有关最近开发的新型滑膜生物标志物和聚合酶链反应（PCR）技术的文献，其中有几种已被证明有望成为检测PJI的高灵敏度和特异性工具。我们遵循了PRISMA（系统评价和Meta分析的首选报告项目）的建议。在通过标题或摘要然后通过全文筛选的90篇论文中，有15篇符合我们的纳入标准。纳入研究报告的α-防御素敏感性范围为63%至100%，白细胞介素6为46.8%至90.9%，白细胞酯酶为28.6%至100%，PCR为67.10%至95.7%。α-防御素的特异性范围为95%至100%，白细胞介素6为85.7%至97.6%，白细胞酯酶为63.6%至96.5%，PCR为12.3%至97.8%。α-防御素是一种高度敏感和特异的筛查工具，可能有助于提高PJI检测的准确性，尤其是在低度感染中。
