D-二聚体与 CRP 和 ESR 联合检测在诊断人工关节置换术后感染中的应用比较。
Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection.
机构信息
Nanchang University, Nanchang, 330003, China.
Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, 330003, China.
出版信息
J Orthop Surg Res. 2019 Jul 29;14(1):240. doi: 10.1186/s13018-019-1282-y.
BACKGROUND
Despite the availability of several biomarkers, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities and has been reported as an inflammatory biomarker. However, quite a few articles have reported the diagnostic efficiency of D-dimer for PJI.
METHODS
This prospective study enrolled patients who had undergone total joint arthroplasty, were suspected of PJI, and also prepared for revision arthroplasty. PJI was defined using the Musculoskeletal Infection Society criteria. In all patients, serum D-dimer level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were measured preoperatively. We then compared the diagnostic efficiency of these three biomarkers.
RESULTS
The median D-dimer level was significantly higher (p < 0.001) for the patients with PJI than for the patients with aseptic failure. With a sensitivity of 80.77% (95% CI, 65.62 to 95.92%) and a specificity of 79.63% (95% CI, 68.89 to 90.37%), the diagnostic efficiency of D-dimer did not outperform serum CRP (with a sensitivity of 84.61% and specificity of 64.81%) and ESR (with a sensitivity of 73.08% and specificity of 90.47%).
CONCLUSIONS
Serum D-dimer as a marker for the diagnosis of PJI still requires more large-scale and detailed clinical trials.
背景
尽管有多种生物标志物可供使用，但假体周围关节感染（PJI）的诊断仍然具有挑战性。血清 D-二聚体检测是一种广泛可用的测试方法，可检测纤维蛋白溶解活性，并已被报道为一种炎症生物标志物。然而，有相当多的文章报道了 D-二聚体对 PJI 的诊断效率。
方法
本前瞻性研究纳入了接受全关节置换术、疑似 PJI 并准备进行翻修关节置换术的患者。PJI 的定义采用肌肉骨骼感染学会标准。在所有患者中，术前均测量血清 D-二聚体水平、红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平。然后，我们比较了这三种生物标志物的诊断效率。
结果
患有 PJI 的患者的 D-二聚体水平明显高于无菌性失败的患者（p<0.001）。D-二聚体的灵敏度为 80.77%（95%可信区间，65.62%至 95.92%），特异性为 79.63%（95%可信区间，68.89%至 90.37%），其诊断效率并不优于血清 CRP（灵敏度为 84.61%，特异性为 64.81%）和 ESR（灵敏度为 73.08%，特异性为 90.47%）。
结论
血清 D-二聚体作为 PJI 的诊断标志物仍需要更多大规模和详细的临床试验。
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