Department of Joint Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China.
Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
J Arthroplasty. 2020 Sep;35(9):2613-2618. doi: 10.1016/j.arth.2020.04.096. Epub 2020 May 7.
The diagnosis of periprosthetic joint infection (PJI), a serious complication after primary total joint arthroplasty, remains challenging. Recently, fibrinolytic activities have been shown to be closely related to infections and inflammation. However, data assessing the value of fibrinolytic markers for the diagnosis of PJI have been sparse until now.
We retrospectively enrolled 157 patients undergoing revision for aseptic loosening (n = 106, group A) or revision for chronic PJI (n = 51, group B) from January 2014 to August 2019. PJI was defined using the Musculoskeletal Infection Society criteria. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), D-dimer, fibrin degradation product (FDP), and fibrinogen were measured preoperatively. The diagnostic values of each biomarker were analyzed and compared using receiver operating characteristic curves, sensitivity, and specificity.
Compared with group A, group B had significantly higher levels of CRP, ESR, D-dimer, FDP, and fibrinogen (P < .001). The area under the curve of fibrinogen was 0.914, which was slightly lower than that of CRP (0.924). FDP and D-dimer had area under the curve values of 0.808 and 0.784, respectively. The optimal threshold, sensitivity, and specificity were 3.56 g/L, 86.27%, and 83.96% for fibrinogen; 1.22 mg/L, 66.67%, and 85.85% for D-dimer; and 3.98 μg/mL, 72.55%, and 80.19% for FDP, respectively.
Fibrinolytic markers provided promising diagnostic support for PJI, especially fibrinogen, which had a diagnostic efficiency similar to that of CRP and ESR.
假体周围关节感染（PJI）是初次全关节置换术后的一种严重并发症，其诊断仍然具有挑战性。最近，纤溶活性与感染和炎症密切相关。然而，目前评估纤溶标志物对 PJI 诊断价值的数据仍然很少。
我们回顾性纳入了 2014 年 1 月至 2019 年 8 月因无菌性松动（n=106，A 组）或慢性 PJI 行翻修术的 157 例患者。PJI 的诊断采用 Musculoskeletal Infection Society 标准。术前检测红细胞沉降率（ESR）、C 反应蛋白（CRP）、D-二聚体、纤维蛋白降解产物（FDP）和纤维蛋白原。使用受试者工作特征曲线、敏感性和特异性分析和比较每种生物标志物的诊断价值。
与 A 组相比，B 组 CRP、ESR、D-二聚体、FDP 和纤维蛋白原水平显著升高（P<0.001）。纤维蛋白原的曲线下面积为 0.914，略低于 CRP（0.924）。FDP 和 D-二聚体的曲线下面积分别为 0.808 和 0.784。纤维蛋白原的最佳截断值、敏感性和特异性分别为 3.56 g/L、86.27%和 83.96%；D-二聚体的最佳截断值、敏感性和特异性分别为 1.22 mg/L、66.67%和 85.85%；FDP 的最佳截断值、敏感性和特异性分别为 3.98 μg/mL、72.55%和 80.19%。
纤溶标志物为 PJI 的诊断提供了有前景的支持，尤其是纤维蛋白原，其诊断效率与 CRP 和 ESR 相似。
