Orthopaedic and Trauma Surgery, University of Duisburg-Essen, Mülheim an der Ruhr, Germany.
Institute of Medical Psychology and Behavioral Immunobiology, University of Duisburg-Essen, Essen, Germany.
Z Orthop Unfall. 2022 Jun;160(3):299-306. doi: 10.1055/a-1303-5105. Epub 2020 Dec 9.
Due to the lack of specificity of conventional diagnostic tools, the prediction of periprosthetic joint infections (PJI) remains challenging. The purpose of this study was to evaluate the accuracy of synovial fluid neopterin, presepsin, and TNF-α as diagnostic parameters and to compare it to the biomarkers recommended in the 2018 definition of periprosthetic hip and knee infection.
Between August 2018 and July 2019, a prospective cohort study was conducted in 80 patients with painful hip, shoulder, and knee arthroplasty. In addition to medical history, clinical and laboratory data were gathered. PJI was diagnosed based on the 2018 definition of periprosthetic hip and knee infection. Synovial joint fluid was analyzed for biomarker measurement using standard quantitative enzyme immunoassay kits.
Fifty-three patients (66%) were classified as the aseptic group and twenty-seven patients (34%) as the PJI group. The mean levels of synovial fluid neopterin were significantly higher (p < 0.01) in the PJI group than those in the aseptic group (aseptic 8.3 ± 6.9 vs. PJI 20.9 ± 21.4 nmol/L). The average values of synovial fluid TNF-α and presepsin were not significantly higher in the PJI group than those in the aseptic group (presepsin: aseptic 0.13 ± 0.19 vs. PJI 0.11 ± 0.32 ng/mL, p = 0.08; TNF-α: aseptic 6.6 ± 7.3 vs. PJI 46.3 ± 123.2 pg/mL, p = 0.17). Synovial fluid neopterin was 59% specific and 74% sensitive with a cut-off value of 7.2 nmol/L. The sensitivity and specificity of synovial fluid TNF-α were 63 and 51% with a cut-off value of 3.9 pg/mL. Synovial fluid presepsin was 51% specific and 29% sensitive with a cut-off value above 0.06 ng/mL.
Synovial fluid neopterin appears to a reliable diagnostic marker for detection of PJI. In contrast, synovial fluid TNF-α and presepsin are not suitable to exclude or diagnose PJI.
由于常规诊断工具特异性不足，假体周围关节感染（PJI）的预测仍然具有挑战性。本研究旨在评估滑液中新蝶呤、降钙素原前肽和 TNF-α作为诊断参数的准确性，并与 2018 年假体周围髋关节和膝关节感染定义中推荐的生物标志物进行比较。
2018 年 8 月至 2019 年 7 月，对 80 例髋关节、肩部和膝关节置换术后疼痛患者进行前瞻性队列研究。除了病史外，还收集了临床和实验室数据。根据 2018 年假体周围髋关节和膝关节感染的定义诊断 PJI。使用标准定量酶免疫测定试剂盒分析滑液中的生物标志物。
53 例（66%）患者被归类为无菌组，27 例（34%）患者被归类为 PJI 组。PJI 组滑液中新蝶呤的平均水平明显高于无菌组（p<0.01；无菌组 8.3±6.9 比 PJI 组 20.9±21.4 nmol/L）。PJI 组与无菌组相比，滑液 TNF-α和降钙素原前肽的平均水平均无明显升高（降钙素原前肽：无菌组 0.13±0.19 比 PJI 组 0.11±0.32 ng/mL，p=0.08；TNF-α：无菌组 6.6±7.3 比 PJI 组 46.3±123.2 pg/mL，p=0.17）。滑液新蝶呤的截断值为 7.2 nmol/L 时，特异性为 59%，敏感性为 74%。滑液 TNF-α的敏感性和特异性分别为 63%和 51%，截断值为 3.9 pg/mL。滑液降钙素原前肽的截断值大于 0.06 ng/mL 时，特异性为 51%，敏感性为 29%。
滑液中新蝶呤似乎是一种可靠的诊断标志物，可用于检测 PJI。相比之下，滑液 TNF-α和降钙素原前肽不适合用于排除或诊断 PJI。
