滑膜 C-反应蛋白试验在全髋关节和膝关节假体周围关节感染诊断中的价值：一项病例对照研究。

Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study.

机构信息

Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.

出版信息

Orthop Traumatol Surg Res. 2021 Jun;107(4):102903. doi: 10.1016/j.otsr.2021.102903. Epub 2021 Mar 26.

DOI:10.1016/j.otsr.2021.102903

PMID:33775885

Abstract

INTRODUCTION

The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI.

MATERIALS AND METHODS

In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria.

RESULTS

The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%).

CONCLUSION

This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI.

LEVEL OF EVIDENCE

III; case-control study.

摘要

简介

假体周围关节感染（PJI）的诊断具有挑战性，需要遵循几个原则。使用诊断生物标志物，如滑液 C 反应蛋白（CRP），似乎很有前景。本研究旨在确定滑液 CRP 是否比血清 CRP 更能区分髋关节和膝关节 PJI 的诊断。

材料与方法

共纳入 194 例患者，均为单中心前瞻性研究：42 例初次关节置换术（对照组 [CG]）、111 例无菌性假体翻修术（无菌性翻修组 [ARG]）和 41 例感染性假体翻修术（感染性翻修组 [SRG]），基于肌肉骨骼感染学会（MSIS）标准。

结果

SRG 患者的血清和滑液 CRP 水平明显高于其他两组（SRG 血清 CRP=75.6mg/L 比 ARG 血清 CRP=6mg/L 和 CG 血清 CRP=2.7mg/L，p<0.001；SRG 滑液 CRP=31.5mg/L 比 CG 滑液 CRP=2.6mg/L 和 ARG 滑液 CRP=1.7mg/L，p<0.001）。滑液 CRP 截断值为 4.4mg/L 时的阳性似然比（LR+）与血清 CRP 截断值为 9mg/L 时的 LR+（LR+=7.04；敏感性 [Se]82.5%，特异性 [Sp]88.3%）非常相似。