血清 D-二聚体作为 PJI 的诊断指标及 PJI 患者病因的回顾性分析。

Serum D-dimer as a diagnostic index of PJI and retrospective analysis of etiology in patients with PJI.

机构信息

Department of Laboratory Medicine, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.

出版信息

Clin Chim Acta. 2020 Jul;506:67-71. doi: 10.1016/j.cca.2020.03.023. Epub 2020 Mar 13.

DOI:10.1016/j.cca.2020.03.023

PMID:32178976

Abstract

OBJECTIVES

To investigate the diagnostic value of serum D-dimer in patients with periprosthetic joint infection (PJI). Moreover, to provide evidence for the treatment of PJI by investigating distribution of pathogenic bacteria and antibiotic resistance situation among the patients.

METHODS

A retrospective study of the medical records of all patients undergoing arthroplasty from the Second Xiangya Hospital of Central South University from 2014 to 2018, 40 patients with periprosthetic joint infection, 37 patients with aseptic loosening and 59 patients with extra-articular infection were selected. The results of serum D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were collected. As well as the bacterial types and antimicrobial susceptibility test results from tissue or joint fluid samples around the prosthetic joint of the patients were collected. All the relevant data were analyzed.

RESULTS

The serum D-dimer, CRP and ESR level were significantly higher in the patients with PJI. The mean D-dimer level was 2.0795 μg/mL in PJI group compared with 0.6854 μg/mL in aseptic loosening group (p = 0.000) and 0.4556 μg/mL in extra-articular infection group (p = 0.000). For diagnosing PJI, the serum D-dimer test demonstrated better sensitivity (87.50%), and better specificity (89.19%); while the serum CRP and ESR had a sensitivity of 80.00% and 82.50% and a specificity of 78.38% and 64.86%, respectively. Moreover, the sensitivity and specificity of ESR and CRP combined was 75.00% and 83.78%, respectively. In addition, 29 strains of pathogens around the prosthesis after arthroplasty were detected, including 22 strains of Gram-positive bacteria, 3 strains of Gram-negative bacteria, and 4 strains of fungi. The staphylococcus was the major pathogen showing high resistance to Cefoxitin and ampicillin.

CONCLUSION

Patients with PJI have high levels of serum D-dimer, which is a promising marker for the diagnosis of PJI. The Gram-positive bacteria are major pathogen in PJI after arthroplasty, and Staphylococcus aureus is the most common organism. Clinical efficacy is significantly improved by reasonable choice of antibiotics and effective medicine education.

摘要

目的

探讨血清 D-二聚体对人工关节置换术后假体周围关节感染（PJI）的诊断价值，并通过对患者的病原菌分布及药敏情况进行分析，为 PJI 的治疗提供依据。

方法

回顾性分析 2014 年至 2018 年中南大学湘雅二医院收治的所有行关节置换术患者的病历资料，选择假体周围关节感染患者 40 例（PJI 组）、无菌性松动患者 37 例（无菌性松动组）和关节外感染患者 59 例（关节外感染组）。收集患者血清 D-二聚体、C 反应蛋白（CRP）和红细胞沉降率（ESR）的检测结果，以及假体周围关节组织或关节液的细菌类型和药敏试验结果。对所有相关数据进行分析。

结果

PJI 患者血清 D-二聚体、CRP 和 ESR 水平均明显升高，PJI 组患者平均 D-二聚体水平为 2.0795μg/ml，明显高于无菌性松动组的 0.6854μg/ml（p=0.000）和关节外感染组的 0.4556μg/ml（p=0.000）。血清 D-二聚体检测诊断 PJI 的敏感度为 87.50%，特异度为 89.19%；血清 CRP 和 ESR 的敏感度分别为 80.00%和 82.50%，特异度分别为 78.38%和 64.86%。此外，ESR 和 CRP 联合检测的敏感度和特异度分别为 75.00%和 83.78%。此外，还检测到 29 株假体周围的病原菌，其中革兰阳性菌 22 株，革兰阴性菌 3 株，真菌 4 株。葡萄球菌对头孢西丁和氨苄西林的耐药率较高。