滑液白细胞介素-16、白细胞介素-18和CRELD2作为人工关节感染的新型生物标志物。
Synovial fluid interleukin-16, interleukin-18, and CRELD2 as novel biomarkers of prosthetic joint infections.
作者信息
Chen M-F, Chang C-H, Yang L-Y, Hsieh P-H, Shih H-N, Ueng S W N, Chang Y
机构信息
Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Bone and Joint Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
Bone Joint Res. 2019 May 3;8(4):179-188. doi: 10.1302/2046-3758.84.BJR-2018-0291.R1. eCollection 2019 Apr.
OBJECTIVES
Prosthetic joint infection (PJI) diagnosis is a major challenge in orthopaedics, and no reliable parameters have been established for accurate, preoperative predictions in the differential diagnosis of aseptic loosening or PJI. This study surveyed factors in synovial fluid (SF) for improving PJI diagnosis.
METHODS
We enrolled 48 patients (including 39 PJI and nine aseptic loosening cases) who required knee/hip revision surgery between January 2016 and December 2017. The PJI diagnosis was established according to the Musculoskeletal Infection Society (MSIS) criteria. SF was used to survey factors by protein array and enzyme-linked immunosorbent assay to compare protein expression patterns in SF among three groups (aseptic loosening and first- and second-stage surgery). We compared routine clinical test data, such as C-reactive protein level and leucocyte number, with potential biomarker data to assess the diagnostic ability for PJI within the same patient groups.
RESULTS
Cut-off values of 1473 pg/ml, 359 pg/ml, and 8.45 pg/ml were established for interleukin (IL)-16, IL-18, and cysteine-rich with EGF-like domains 2 (CRELD2), respectively. Receiver operating characteristic curve analysis showed that these factors exhibited an accuracy of 1 as predictors of PJI. These factors represent potential biomarkers for decisions associated with prosthesis reimplantation based on their ability to return to baseline values following the completion of debridement.
CONCLUSION
IL-16, IL-18, and CRELD2 were found to be potential biomarkers for PJI diagnosis, with SF tests outperforming blood tests in accuracy. These factors could be useful for assessing successful debridement based on their ability to return to baseline values following the completion of debridement.: M-F. Chen, C-H. Chang, L-Y. Yang, P-H. Hsieh, H-N. Shih, S. W. N. Ueng, Y. Chang. Synovial fluid interleukin-16, interleukin-18, and CRELD2 as novel biomarkers of prosthetic joint infections. 2019;8:179-188. DOI: 10.1302/2046-3758.84.BJR-2018-0291.R1.
目的
人工关节感染（PJI）的诊断是骨科领域的一项重大挑战，目前尚未建立可靠的参数用于在无菌性松动或PJI的鉴别诊断中进行准确的术前预测。本研究调查了滑液（SF）中的因素以改善PJI的诊断。
方法
我们纳入了2016年1月至2017年12月期间需要进行膝/髋关节翻修手术的48例患者（包括39例PJI和9例无菌性松动病例）。PJI的诊断根据肌肉骨骼感染协会（MSIS）标准确定。通过蛋白质阵列和酶联免疫吸附测定法利用滑液调查相关因素，以比较三组（无菌性松动以及一期和二期手术）滑液中的蛋白质表达模式。我们将常规临床检测数据，如C反应蛋白水平和白细胞数量，与潜在生物标志物数据进行比较，以评估同一患者组内PJI的诊断能力。
结果
分别确定白细胞介素（IL）-16、IL-18和富含EGF样结构域2的半胱氨酸蛋白（CRELD2）的临界值为1473 pg/ml、359 pg/ml和8.45 pg/ml。受试者工作特征曲线分析表明，这些因素作为PJI的预测指标，准确率为1。基于这些因素在清创完成后恢复到基线值的能力，它们代表了与假体再植入相关决策的潜在生物标志物。
结论
发现IL-16、IL-18和CRELD2是PJI诊断的潜在生物标志物，滑液检测在准确性方面优于血液检测。基于这些因素在清创完成后恢复到基线值的能力，它们可用于评估清创是否成功。：陈美芳 - 张政宏 - 杨立言 - 谢秉翰 - 施宏男 - 翁瑞南 - 张育仁。滑液白细胞介素-16、白细胞介素-18和CRELD2作为人工关节感染的新型生物标志物。2019；8：179 - 188。DOI：10.1302/2046 - 3758.84.BJR - 2018 - 0291.R1
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