Huang Jiaxing, Wang Jiawei, Qin Leilei, Zhu Bo, Huang Wei, Hu Ning
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Orthopedic Laboratory of Chongqing Medical University, Chongqing, China.
Front Surg. 2022 Mar 9;9:843187. doi: 10.3389/fsurg.2022.843187. eCollection 2022.
Synovial fluid biomarkers have been found to improve the diagnosis of chronic periprosthetic joint infection (PJI); however, no "gold standard" exists yet. Interleukin-4 (IL-4) and polymorphonuclear cell (neutrophil) count in the synovial fluid are crucial in mediating local inflammation during bacterial infections and could be valuable biomarkers for PJI.
This prospective study was conducted to investigate the diagnostic potential of synovial fluid IL-4 (SF-IL4) and polymorphonuclear cell percentage (SF-PMN%) for chronic PJI. A total of 110 patients who underwent revision arthroplasty between January 2019 and October 2020 were enrolled, and 11 patients were excluded. Of 99 patients, 43 were classified as having PJI and 56 as having aseptic failures according to the 2013 Musculoskeletal Infections Society criteria. In all patients, SF-IL4, SF-PMN%, serum C-reactive protein (CRP), and serum erythrocyte sedimentation rate (ESR) were quantified preoperatively. The diagnostic value for each biomarker was analyzed, and optimal cutoff values were calculated.
The patient demographics did not significantly vary. The area under the curve of SF-IL4 and SF-PMN% was 0.97 and 0.89, respectively, higher than that for serum ESR (0.72) and serum CRP (0.83). The combination of SF-IL4 and SF-PMN% provided higher specificity (97.0%) and accuracy (96.0%) when the cut-off values were 1.7 pg/mL and 75%, respectively.
SF-IL4 is a valuable biomarker for chronic PJI detection, and the combination of SF-IL4 and SF-PMN% improved the diagnostic value of chronic PJI, and further studies are needed until its clinical application.
已发现滑液生物标志物可改善慢性人工关节周围感染（PJI）的诊断；然而，目前尚无“金标准”。滑液中的白细胞介素-4（IL-4）和多形核细胞（中性粒细胞）计数在细菌感染期间介导局部炎症中起关键作用，可能是PJI的有价值生物标志物。
进行这项前瞻性研究以调查滑液IL-4（SF-IL4）和多形核细胞百分比（SF-PMN%）对慢性PJI的诊断潜力。纳入了2019年1月至2020年10月期间接受翻修关节成形术的110例患者，排除11例患者。根据2013年肌肉骨骼感染学会标准，99例患者中，43例被分类为患有PJI，56例被分类为无菌性失败。对所有患者术前定量检测SF-IL4、SF-PMN%、血清C反应蛋白（CRP）和血清红细胞沉降率（ESR）。分析每个生物标志物的诊断价值，并计算最佳临界值。
患者人口统计学特征无显著差异。SF-IL4和SF-PMN%的曲线下面积分别为0.97和0.89，高于血清ESR（0.72）和血清CRP（0.83）。当临界值分别为1.7 pg/mL和75%时，SF-IL4和SF-PMN%的组合具有更高的特异性（97.0%）和准确性（96.0%）。
SF-IL4是慢性PJI检测的有价值生物标志物，SF-IL4和SF-PMN%的组合提高了慢性PJI的诊断价值，在其临床应用之前还需要进一步研究。
