Wang Chi, Li Rui, Wang Qi, Wang Chengbin
1 Department of Clinical Laboratory Diagnosis, PLA General Hospital , Beijing, China .
2 Department of Orthopedics, PLA General Hospital , Beijing, China .
Surg Infect (Larchmt). 2018 Apr;19(3):245-253. doi: 10.1089/sur.2017.192. Epub 2017 Nov 3.
Peri-prosthetic joint infection (PJI) is a serious and frequent complication of total joint arthroplasty (TJA). Recently, synovial fluid leukocyte esterase (LE), measurement of which is convenient and fast, has been examined as a marker of PJI. We summarized the articles describing synovial fluid LE as a biomarker for the diagnosis of PJI and assessed its diagnostic value in patients suspected of having PJI.
We searched with appropriate key words in PubMed, Embase, Web of Science, the Cochrane database, and Science Direct. Eligible studies providing sufficient data to construct 2 × 2 contingency tables were chosen on the basis of several criteria, and the quality of the chosen studies was assessed. The pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated for those studies. The summary receiver operating characteristic (SROC) curve and the area under the SROC (AUSROC) were used to evaluate the overall diagnostic performance of LE.
Eleven studies were found suitable for this systematic review. Among them, eight articles with a total of 1,011 participants qualified for meta-analysis. The pooled sensitivity, specificity, and DOR were 0.90 (95% confidence interval [CI] 0.76-0.96), 0.97 (95% CI 0.95-0.98), and 310.76 (95% CI 103.86-929.88), respectively. The SROC was 0.98 (95% CI 0.96-0.99). Sub-group analysis indicated that the sample inclusion criteria might be the main source of heterogeneity. Publication bias was suggested by an asymmetrical funnel plot (p = 0.144).
Although the result of synovial fluid LE assay can be influenced by sample-related factors, it is more specific as a means to exclude PJI.
人工关节周围感染（PJI）是全关节置换术（TJA）一种严重且常见的并发症。近来，滑膜液白细胞酯酶（LE）因其检测便捷快速，已被作为PJI的一项标志物进行研究。我们总结了描述滑膜液LE作为诊断PJI生物标志物的文章，并评估其在疑似PJI患者中的诊断价值。
我们在PubMed、Embase、科学网、Cochrane数据库及Science Direct中使用恰当关键词进行检索。根据多项标准选择有足够数据构建2×2列联表的合格研究，并评估所选研究的质量。计算这些研究的合并敏感度、特异度及诊断比值比（DOR）。采用汇总受试者工作特征（SROC）曲线及SROC曲线下面积（AUSROC）评估LE的整体诊断性能。
发现11项研究适合本系统评价。其中，8篇文章共1011名参与者符合荟萃分析条件。合并敏感度、特异度及DOR分别为0.90（95%置信区间[CI] 0.76 - 0.96）、0.97（95% CI 0.95 - 0.98）及310.76（95% CI 103.86 - 929.88）。SROC为0.98（95% CI 0.96 - 0.99）。亚组分析表明样本纳入标准可能是异质性的主要来源。不对称漏斗图提示存在发表偏倚（p = 0.144）。
尽管滑膜液LE检测结果可能受样本相关因素影响，但作为排除PJI的手段，其特异性更高。
