中性粒细胞与淋巴细胞比值作为早期人工关节周围感染诊断的预测指标。

Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection.

机构信息

Department of Orthopaedics, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, Haidian District, China.

Department of Orthopaedics, Bao Ding GemFlower Eastern Hospital, Bao Ding, Hebei, P. R. China.

出版信息

BMC Musculoskelet Disord. 2020 Oct 27;21(1):706. doi: 10.1186/s12891-020-03704-5.

DOI:10.1186/s12891-020-03704-5

PMID:33109144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7592373/

Abstract

BACKGROUND

Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty.

METHODS

We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated.

RESULTS

The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X10 /L and 6.1 X10 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632).

CONCLUSIONS

This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

摘要

背景

假体周围关节感染（PJI）是全膝关节或髋关节置换术后的灾难性并发症。PJI 的诊断非常困难，尤其是在术后早期。中性粒细胞与淋巴细胞比值（NLR）对诊断感染性疾病具有一定价值。本研究旨在探讨 NLR 对全膝关节或髋关节置换术后早期 PJI 的诊断准确性。

方法

我们回顾性评估了 2011 年 1 月至 2018 年 10 月连续行初次全膝关节或髋关节置换术的患者，并确定了术后 90 天内再次入院的患者。根据改良的肌肉骨骼感染协会（MSIS）标准，我们确定了 20 例早期 PJI 患者和 101 例未感染患者。比较两组患者的血清 C 反应蛋白（CRP）、红细胞沉降率（ESR）、白细胞（WBC）计数、NLR 和白细胞介素-6（IL-6）。生成受试者工作特征曲线以估计每个参数的最佳截断值。计算每个参数的灵敏度、特异性、阳性预测值和阴性预测值。

结果

感染组的 CRP、ESR、WBC、NLR 和 IL-6 值均显著高于未感染组。感染组 CRP 的中位数为 66.6mg/L，未感染组为 8.6mg/L（p<0.001）。感染组 ESR 的中位数为 34.8mm/hr，未感染组为 17.4mm/hr（p<0.001）。在感染组和未感染组中，WBC 的中位数分别为 8.2X10/L 和 6.1X10/L（p=0.002），而 NLR 的中位数分别为 5.2 和 2.1（p<0.001）。IL-6 的中位数分别为 46pg/ml 和 6.4pg/ml（p<0.001）。诊断早期 PJI 的最佳参数是 IL-6（AUC=0.814），其次是 NLR（AUC=0.802）、CRP（AUC=0.793）、ESR（AUC=0.744）和 WBC（AUC=0.632）。