Miao R Q, Cao L, Nueraijiang Yushan, Zhang X G, Wuhuzi Wulamu, Ren J D, Jiang R D, Wang Q
Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.
School of Public Health, Xinjiang Medical University, Urumqi 830011, China.
Zhonghua Wai Ke Za Zhi. 2020 Jun 1;58(6):464-468. doi: 10.3760/cma.j.cn112139-20191106-00550.
To investigate the diagnose value of D-dimer for chronic periprosthetic infection (PJI) after hip and knee arthroplasty. A retrospective analyze was conducted on 168 patients underwent revision arthroplasty and primary arthroplasty at the First Affiliated Hospital of Xinjiang Medical University from November 2017 to December 2018.There were 58 males and 110 females, aged(58.6±14.5)years.There were 48 cases of chronic PJI (21 cases of knee joint, 27 cases of hip joint), 57 cases of aseptic loosening (16 cases of knee joint, 41 cases of hip joint), and 63 cases of normal follow-up patients after hip (35 cases) or knee (28 cases) arthroplasty.The levels of D-dimer, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected.The levels of D-dimer in patients with chronic PJI of hip and knee joints were compared by Mann-Whitney test.The diagnostic efficacy of D-dimer, ESR and CRP in chronic PJI of hip and knee joints was analyzed by receiver operator curve (ROC). The D-dimer level was significantly higher in knee chronic PJI patients than hip chronic PJI patients( (()) ) (1 040 (1 140.5) μg/L .435 (605) μg/L, 3.169, 0.002) . ROC analysis showed that the optimum cutoff value of D-dimer in the diagnosis of chronic PJI was 370.5 μg/L, the sensitivity was 90.5%, the specificity was 84.1%; the optimum cutoff value of CRP was 9.3 mg/L, the sensitivity was 95.2%, the specificity was 90.9%, the optimum cutoff value of ESR was 33 mm/h, the sensitivity was 90.5%, and the specificity was 88.6%.The optimum cutoff value of D-dimer in the diagnosis of chronic PJI of hip joint is 294 μg/L, the sensitivity of diagnosis is 66.7%, the specificity is 77.6%; the optimum cutoff value of ESR is 45 mm/h, the sensitivity of diagnosis is 55.6% , the specificity is 97.4%; the optimum cutoff value of CRP is 8.1 mg/L, the sensitivity of diagnosis is 74.1%, the specificity is 84.2%. The value of D-dimer in the diagnosis of chronic PJI of knee joint is higher than that of hip joint, but the value of D-dimer in the diagnosis of chronic PJI is not better than ESR and CRP.
探讨D-二聚体对髋膝关节置换术后慢性假体周围感染（PJI）的诊断价值。对2017年11月至2018年12月在新疆医科大学第一附属医院接受翻修置换术和初次置换术的168例患者进行回顾性分析。其中男性58例，女性110例，年龄（58.6±14.5）岁。慢性PJI患者48例（膝关节21例，髋关节27例），无菌性松动患者57例（膝关节16例，髋关节41例），髋（35例）或膝（28例）关节置换术后正常随访患者63例。收集D-二聚体、红细胞沉降率（ESR）和C反应蛋白（CRP）水平。采用Mann-Whitney检验比较髋膝关节慢性PJI患者的D-二聚体水平。通过受试者工作特征曲线（ROC）分析D-二聚体、ESR和CRP对髋膝关节慢性PJI的诊断效能。膝关节慢性PJI患者的D-二聚体水平显著高于髋关节慢性PJI患者（（（）））（1040（1140.5）μg/L.435（605）μg/L，3.169，0.002）。ROC分析显示，D-二聚体诊断慢性PJI的最佳截断值为370.5μg/L，敏感性为90.5%，特异性为84.1%；CRP的最佳截断值为9.3mg/L，敏感性为95.2%，特异性为90.9%，ESR的最佳截断值为33mm/h，敏感性为90.5%，特异性为88.6%。D-二聚体诊断髋关节慢性PJI的最佳截断值为294μg/L，诊断敏感性为66.7%，特异性为77.6%；ESR的最佳截断值为45mm/h，诊断敏感性为55.6%，特异性为97.4%；CRP的最佳截断值为8.1mg/L，诊断敏感性为74.1%，特异性为84.2%。D-二聚体对膝关节慢性PJI的诊断价值高于髋关节，但D-二聚体对慢性PJI的诊断价值不如ESR和CRP。
