哪些血清标志物可预测假体周围关节感染后再植入的成功率？
Which serum markers predict the success of reimplantation after periprosthetic joint infection?
机构信息
Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, China.
出版信息
J Orthop Traumatol. 2022 Sep 16;23(1):45. doi: 10.1186/s10195-022-00664-5.
PURPOSE
In clinical practice, serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels are routinely used to screen for periprosthetic joint infection (PJI), but the effectiveness of predicting the success of reimplantation is variable. This study aimed to evaluate the diagnostic effectiveness of serum CRP, ESR, plasma D-dimer, and fibrinogen values in groups achieving treatment success or failure for PJI.
METHODS
A total of 119 PJI cases between January 2012 and January 2017 were identified and included in this study. The most recent serum CRP, ESR, plasma D-dimer, and fibrinogen values obtained prior to performing second-stage revision or spacer exchange were collected for analysis. Treatment failure was defined as having been unable to undergo reimplantation due to clinically persistent infection or reinfection after reimplantation.
RESULTS
All these tests showed significantly lower values in the treatment success group than in the treatment failure group. The optimal cutoff serum CRP, ESR, plasma D-dimer, and fibrinogen levels for predicting the success of reimplantation were 9.4 mg/L, 29 mm/h, 1740 ng/mL, and 365.6 mg/dL, respectively. All tests had the same sensitivity (72.7%) except for ESR (63.6%), while their specificities were 92.6%, 88.0%, 72.3%, and 83.2%, respectively. Plasma fibrinogen had the highest AUC value of 0.831 [95% confidence interval (CI), 0.685 to 0.978], followed by serum CRP (0.829) and ESR (0.795); plasma D-dimer had the lowest AUC value of 0.716 (95% CI, 0.573 to 0.859).
CONCLUSION
Plasma CRP and fibrinogen are good tests for predicting reimplantation success after two-stage revision procedures for patients with PJI.
目的
在临床实践中，血清 C 反应蛋白（CRP）和红细胞沉降率（ESR）水平通常用于筛查假体周围关节感染（PJI），但预测再植入成功的效果各不相同。本研究旨在评估 CRP、ESR、血浆 D-二聚体和纤维蛋白原水平在 PJI 治疗成功或失败组中的诊断效果。
方法
共纳入 2012 年 1 月至 2017 年 1 月期间的 119 例 PJI 患者，收集其在进行二期翻修或间隔交换前最近一次的血清 CRP、ESR、血浆 D-二聚体和纤维蛋白原值进行分析。治疗失败定义为因临床持续感染或再植入后再次感染而无法进行再植入。
结果
所有这些测试在治疗成功组中的值均显著低于治疗失败组。预测再植入成功的最佳截断血清 CRP、ESR、血浆 D-二聚体和纤维蛋白原水平分别为 9.4mg/L、29mm/h、1740ng/mL 和 365.6mg/dL。所有测试的敏感性均相同（72.7%），除了 ESR（63.6%），而特异性分别为 92.6%、88.0%、72.3%和 83.2%。血浆纤维蛋白原的 AUC 值最高，为 0.831（95%CI，0.685 至 0.978），其次是血清 CRP（0.829）和 ESR（0.795）；血浆 D-二聚体的 AUC 值最低，为 0.716（95%CI，0.573 至 0.859）。
结论
在 PJI 患者的二期翻修术后，血浆 CRP 和纤维蛋白原是预测再植入成功的良好检测方法。
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