Zhang Zeyu, Cai Yuanqing, Bai Guochang, Zhang Chaofan, Li Wenbo, Yang Bin, Zhang Wenming
Department of Orthopaedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Laboratory Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Bone Joint Res. 2020 Aug 11;9(8):450-457. doi: 10.1302/2046-3758.98.BJR-2019-0329.R2. eCollection 2020 Aug.
This study aimed to evaluate calprotectin in synovial fluid for diagnosing chronic prosthetic joint infection (PJI) .
A total of 63 patients who were suspected of PJI were enrolled. The synovial fluid calprotectin was tested by an enzyme-linked immunosorbent assay (ELISA). Laboratory test data, such as ESR, CRP, synovial fluid white blood cells (SF-WBCs), and synovial fluid polymorphonuclear cells (SF-PMNs), were documented. Chi-squared tests were used to compare the sensitivity and specificity of calprotectin and laboratory tests. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated to determine diagnostic efficacy.
The median calprotectin level was 776 μg/ml (interquartile range (IQR) 536.5 to 1132) in the PJI group and 54.5 μg/ml (IQR, 38.75 to 78.25) in the aseptic failure (AF) group (p < 0.05). Using a threshold of 173 ug/ml, the sensitivity was 95.2%, with a 97.6% specificity, and the AUC was 0.993. The sensitivity of calprotectin of the antibiotic-treated PJI group was 100% versus 90.9% of the non-antibiotic-treated PJI group. Although 47.6% (ten cases) of the patients in the PJI group received antibiotics before aspiration, the diagnostic efficacy of calprotectin was not affected. The sensitivity and specificity of ESR, CRP, SF-WBCs, and SF-PMNs ranged from 76.2% to 90.5% and 64.3% to 85.7%, respectively.
Calprotectin in synovial fluid has great diagnostic efficacy for PJI diagnosisand outperformed ESR, CRP, SF-WBCs, and SF-PMNs.Cite this article: 2020;9(8):450-457.
本研究旨在评估滑液中的钙卫蛋白用于诊断慢性人工关节感染（PJI）。
共纳入63例疑似PJI的患者。采用酶联免疫吸附测定（ELISA）检测滑液中的钙卫蛋白。记录血沉（ESR）、C反应蛋白（CRP）、滑液白细胞（SF-WBC）和滑液多形核白细胞（SF-PMN）等实验室检测数据。采用卡方检验比较钙卫蛋白和实验室检测的敏感性和特异性。计算受试者工作特征（ROC）曲线的曲线下面积（AUC）以确定诊断效能。
PJI组钙卫蛋白水平中位数为776μg/ml（四分位间距（IQR）536.5至1132），无菌性失败（AF）组为54.5μg/ml（IQR，38.75至78.25）（p<0.05）。以173μg/ml为阈值，敏感性为95.2%，特异性为97.6%，AUC为0.993。抗生素治疗的PJI组钙卫蛋白敏感性为100%，而非抗生素治疗的PJI组为90.9%。尽管PJI组47.6%（10例）患者在抽吸前接受了抗生素治疗，但钙卫蛋白的诊断效能未受影响。ESR、CRP、SF-WBC和SF-PMN的敏感性和特异性分别为76.2%至90.5%和64.3%至85.7%。
滑液中的钙卫蛋白对PJI诊断具有很高的诊断效能，且优于ESR、CRP、SF-WBC和SF-PMN。引用本文：2020；9(8):450-457。
