血浆纤维蛋白原在假体周围关节感染诊断中的出色表现。
Exciting Performance of Plasma Fibrinogen in Periprosthetic Joint Infection Diagnosis.
机构信息
Department of Orthopaedics, Henan Provincial People's Hospital, Zhengzhou, China.
Department of Orthopaedics, People's Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Orthop Surg. 2021 May;13(3):812-816. doi: 10.1111/os.12964. Epub 2021 Mar 15.
OBJECTIVE
To test the significance of serum C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), the platelet count/mean platelet volume ratio (PC/MPV), plasma fibrinogen, and D-Dimer in periprosthetic joint infection (PJI) diagnosis.
METHODS
We retrospectively analyzed the clinical data of 149 patients diagnosed from July 2016 to December 2019 with primary osteoarthritis (OA group, average age 63.18 years [range, 53-82 years] 18 males, 46 females), PJI (PJI group, average age 63.74 years [range, 52-81 years], 16 males, 31 females), and aseptic loosening (aseptic group, average age 63.18 years [range, 53-80 years], 12 male, 26 female) in our department. Demographic data and the sensitivity and specificity of preoperative CRP, ESR, PC/MPV, fibrinogen, and D-Dimer in PJI diagnosis were compared.
RESULTS
There were no significant differences when the demographic data of the three groups were compared. The expression level of CRP (50.67 ± 58.98 mg/L), ESR (50.55 ± 25.81 mm/h), PC/MPV (35.79 ± 18.00), and fibrinogen (4.85 ± 1.33 μg/mL) in the PJI group were higher than in the OA group (CRP: 4.09 ± 9.68 mg/L; ESR:13.44 ± 9.32 mm/1 h; PC/MPV: 24.97 ± 7.58; fibrinogen: 3.09 ± 0.55 μg/mL) and the aseptic group (CRP: 7.01 ± 11.83 mg/L; ESR: 22.47 ± 17.53 mm/1 h; PC/MPV: 25.18 ± 11.48; fibrinogen: 3.39 ± 0.80 μg/mL), respectively. The expression level of plasma D-dimer (1.60 ± 1.29 mg/L) in the PJI group was higher than in the OA group (0.49 ± 0.42 mg/L) but similar to that in the aseptic group (1.21 ± 1.35 mg/L). Receiver operating characteristic (ROC) curve analysis demonstrated that the areas under the ROC curve (AUC) for CRP, ESR, PC/MPV, fibrinogen, and D-dimer were 0.892 (95% confidence interval, 0.829-0.954), 0.888 (0.829-0.947), 0.686 (0.589-0.784), 0.873 (0.803-0.943), and 0.835 (0.772-0.899), respectively. When PC/MPV > 31.70, fibrinogen >4.01 μg/mL, and D-dimer >1.17 mg/L were set as the threshold values for the diagnosis of PJI, the sensitivity of PC/MPV in PJI diagnosis was lower than that of ESR and plasma fibrinogen. In contrast, there was no significant difference when comparing the specificity of CRP, ESR, PC/MPV, fibrinogen, and D-dimer in PJI diagnosis.
CONCLUSION
Plasma fibrinogen is a good new auxiliary diagnostic marker for PJI.
目的
探讨血清 C 反应蛋白（CRP）、红细胞沉降率（ESR）、血小板计数/平均血小板体积比值（PC/MPV）、血浆纤维蛋白原和 D-二聚体在人工关节置换术后感染（PJI）诊断中的意义。
方法
回顾性分析我院 2016 年 7 月至 2019 年 12 月收治的 149 例原发性骨关节炎（OA 组，平均年龄 63.18 岁[范围，53-82 岁]，男 18 例，女 46 例）、PJI（PJI 组，平均年龄 63.74 岁[范围，52-81 岁]，男 16 例，女 31 例）和无菌性松动（无菌组，平均年龄 63.18 岁[范围，53-80 岁]，男 12 例，女 26 例）患者的临床资料。比较三组患者术前 CRP、ESR、PC/MPV、纤维蛋白原和 D-二聚体的灵敏度和特异性。
结果
三组患者的一般资料比较，差异无统计学意义。PJI 组 CRP（50.67±58.98 mg/L）、ESR（50.55±25.81 mm/h）、PC/MPV（35.79±18.00）和纤维蛋白原（4.85±1.33 μg/mL）的表达水平均高于 OA 组（CRP：4.09±9.68 mg/L；ESR：13.44±9.32 mm/1 h；PC/MPV：24.97±7.58；纤维蛋白原：3.09±0.55 μg/mL）和无菌组（CRP：7.01±11.83 mg/L；ESR：22.47±17.53 mm/1 h；PC/MPV：25.18±11.48；纤维蛋白原：3.39±0.80 μg/mL）。PJI 组血浆 D-二聚体（1.60±1.29 mg/L）的表达水平高于 OA 组（0.49±0.42 mg/L），但与无菌组相似（1.21±1.35 mg/L）。受试者工作特征（ROC）曲线分析显示，CRP、ESR、PC/MPV、纤维蛋白原和 D-二聚体的 ROC 曲线下面积（AUC）分别为 0.892（95%置信区间，0.829-0.954）、0.888（0.829-0.947）、0.686（0.589-0.784）、0.873（0.803-0.943）和 0.835（0.772-0.899）。当 PC/MPV>31.70、纤维蛋白原>4.01 μg/mL 和 D-二聚体>1.17 mg/L 时，将其设定为 PJI 诊断的阈值，PC/MPV 对 PJI 诊断的敏感性低于 ESR 和血浆纤维蛋白原。相比之下，CRP、ESR、PC/MPV、纤维蛋白原和 D-二聚体在 PJI 诊断中的特异性无显著差异。
结论
血浆纤维蛋白原是 PJI 的一种良好的新型辅助诊断标志物。
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