Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany.
Department of Orthopaedics and Trauma Surgery, Ev. Waldkrankenhaus Bonn, Bonn, Germany.
Arch Orthop Trauma Surg. 2020 Dec;140(12):1883-1890. doi: 10.1007/s00402-020-03388-5. Epub 2020 Mar 5.
Diagnosing a (low-grade) periprosthetic joint infection (PJI) after hip or knee arthroplasty remains a diagnostic challenge. The aim of this study was to evaluate the utility of using a novel multiplex protein microarray system for synovial biomarkers in determining PJI in patients undergoing revision knee or hip arthroplasty.
The individual synovial fluid levels of 12 cytokines (IL-1b, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-17, GM-CSF, TNF-α, and INF-γ) were analysed with a novel multiplex protein microarray system in 32 patients undergoing revision hip (n = 22) or knee (n = 10) arthroplasty. Cases were classified into septic and aseptic groups on basis of pre- and interoperative findings: [PJI (n = 14) vs. non-PJI (n = 18)]. Receiver operator characteristic (ROC) curves were calculated to assess the discriminatory strength of the individual parameters. A multiple regression model was used to determine the utility of using a combination of the tested cytokines to determine the infection status.
The levels of all of the evaluated cytokines were significantly elevated in the PJI-group. Best sensitivity and specificity were found for IL-6, followed by IL-1b, IL-10, and IL-17. The multiple regression models revealed a combination of IL-2, IL-4, IL-5, IL6, lL-12, and GM-CSF to be associated with the best sensitivity (100%) and specificity (88.9%) for a cut-off value of 0.41, with a likelihood ratio of 9.0.
Analysis of individual synovial fluid cytokine levels showed both high sensitivity and high specificity in diagnosing PJI. A combined model using several cytokines showed even higher sensitivity and specificity in diagnosing PJI and could thus be a useful predictive tool to determine the probability of PJI in patients with a painful prosthesis.
Diagnostic IV.
髋关节或膝关节置换术后诊断（低级别）假体周围关节感染（PJI）仍然是一个具有挑战性的诊断问题。本研究旨在评估使用新型多指标蛋白微阵列系统检测关节滑液生物标志物在确定行膝关节或髋关节翻修术患者 PJI 中的作用。
使用新型多指标蛋白微阵列系统分析 32 例（髋关节翻修术 22 例，膝关节翻修术 10 例）患者关节滑液中 12 种细胞因子（IL-1b、IL-2、IL-4、IL-5、IL-6、IL-8、IL-10、IL-12、IL-17、GM-CSF、TNF-α和 IFN-γ）的水平。根据术前和术中发现，将病例分为感染组（n=14）和非感染组（n=18）：[PJI（n=14）与非 PJI（n=18）]。计算受试者工作特征（ROC）曲线以评估各参数的鉴别力。使用多元回归模型确定使用测试细胞因子组合来确定感染状态的效用。
感染组所有评估细胞因子的水平均显著升高。IL-6 的敏感性和特异性最好，其次是 IL-1b、IL-10 和 IL-17。多元回归模型显示，IL-2、IL-4、IL-5、IL6、IL-12 和 GM-CSF 的组合与最佳敏感性（100%）和特异性（88.9%）相关，截断值为 0.41，优势比为 9.0。
分析关节滑液中单个细胞因子水平对诊断 PJI 具有较高的敏感性和特异性。使用几种细胞因子的组合模型在诊断 PJI 方面具有更高的敏感性和特异性，因此可能是一种有用的预测工具，用于确定假体周围疼痛患者发生 PJI 的概率。
诊断 IV 级。
