关节液α-防御素和白细胞酯酶诊断人工关节周围感染（PJI）的可靠性：系统评价和荟萃分析。
Reliability of synovial fluid alpha-defensin and leukocyte esterase in diagnosing periprosthetic joint infection (PJI): a systematic review and meta-analysis.
机构信息
Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People' s Hospital, Ear Institute, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
J Orthop Surg Res. 2019 Dec 19;14(1):453. doi: 10.1186/s13018-019-1395-3.
BACKGROUND
Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI.
METHODS
We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis.
RESULTS
After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84-90%), 96% (95% CI 95-97%), and 170.09 (95% CI 97.63-296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83-90%), 97% (95% CI 96-98%), and 158.18 (95% CI 74.26-336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively.
CONCLUSION
Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.
背景
在最近的研究论文中，滑液蛋白已被用作假体周围关节感染（PJI）的诊断生物标志物。因此，本荟萃分析旨在评估滑液α-防御素和白细胞酯酶（LE）对 PJI 的诊断效率。
方法
我们通过在在线数据库（如 PubMed、Embase、Cochrane、Elsevier、Springer 和 Web of Science）中搜索关键词，从数据库建立到 2018 年 10 月进行了系统综述。纳入标准如下：接受膝关节、髋关节或肩关节置换术的患者；滑液中的α-防御素或白细胞酯酶（LE 条带）被检测为 PJI 诊断的生物标志物；和肌肉骨骼感染学会（MSIS）或结合临床数据被认为是金标准。为评估滑液α-防御素和 LE 对 PJI 的诊断，对纳入的研究计算了包括敏感性、特异性、诊断优势比（DOR）和汇总受试者工作特征曲线下面积（AUSROC）在内的诊断参数。
结果
经过全文审查，有 28 项研究符合本系统综述的要求，其中 16 项研究使用α-防御素，另外 12 项研究使用 LE 条带。LE 条带的汇总敏感性、特异性和 DOR 分别为 87%（95%CI 84-90%）、96%（95%CI 95-97%）和 170.09（95%CI 97.63-296.32），而α-防御素的汇总敏感性、特异性和 DOR 分别为 87%（95%CI 83-90%）、97%（95%CI 96-98%）和 158.18（95%CI 74.26-336.91）。LE 条带和α-防御素的 AUSROC 分别为 0.9818 和 0.9685。
结论
滑液中的 LE 条带和α-防御素均可快速方便地诊断 PJI。α-防御素和 LE 条带的敏感性相同，而这两种方法在临床实践中都具有很高的特异性。
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