白细胞酯酶和α-防御素在假体周围关节感染中的应用：一项前瞻性研究中的预测质量和相关性。
Leukocyte esterase and alpha-defensin in periprosthetic joint infection: predictive quality and correlation in a prospective study.
机构信息
Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstrasse 95, 72076, Tuebingen, Germany.
Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany.
出版信息
Int Orthop. 2023 Nov;47(11):2663-2668. doi: 10.1007/s00264-023-05914-7. Epub 2023 Aug 16.
PURPOSE
Periprosthetic joint infection (PJI) is a rare but serious complication of total joint arthroplasty (TJA). An accurate diagnosis of PJI preoperatively does not exist. Alpha-defensin (AD) is a proven and common indicator. The diagnostic marker of leukocyte esterase (LE) promises some advantages: feasibility, availability, and fast result reporting. The aim of this study was the evaluation of the predictive quality and correlation between both diagnostic tools in the diagnosis of PJI.
METHODS
A prospective study was conducted between April 2018 and August 2022. All patients with suspicion of PJI on hip and knee joint were included and underwent a routine and standardized joint punction. For laboratory diagnostics of AD, the synovial liquid was analyzed by ELISA. The sample was additionally applied to a LE test strip (Combur 10 Test, Roche Diagnostics, Mannheim, Germany).
RESULTS
A total of 249 patients were examined (mean age 67.12 ± 11.89; gender distribution man/woman 139 (55.8%)/110(44.2%), hip/knee 71(28.5%)/178 (71.5%). According to EBJIS criteria, PJI was diagnosed in 54 (21.7%) patients. AD showed excellent results with an AUC of 0.930 (sensitivity/specificity 0.870/0.990). LE yielded very good results with an AUC of 0.820 (sensitivity/specificity 0.722/0.918). Both parameters showed a strong positive correlation.
CONCLUSION
LE is a rapidly available alternative in PJI diagnostics. The simultaneous determination of both markers may enhance diagnostic reliability. A routine usage may shorten the time from diagnosis to treatment of PJI.
目的
假体周围关节感染（PJI）是全关节置换术（TJA）的一种罕见但严重的并发症。目前还没有一种准确的术前 PJI 诊断方法。α-防御素（AD）是一种已被证实的常用指标。白细胞酯酶（LE）的诊断标志物具有一定的优势：可行性、可用性和快速报告结果。本研究旨在评估这两种诊断工具在 PJI 诊断中的预测质量和相关性。
方法
本研究为前瞻性研究，于 2018 年 4 月至 2022 年 8 月进行。所有疑似髋关节和膝关节 PJI 的患者均纳入本研究，并接受常规和标准化关节穿刺。采用 ELISA 法对 AD 进行滑膜液分析。该样本还应用于 LE 测试条（罗氏诊断公司，曼海姆，德国的 Combur 10 测试）。
结果
共检查了 249 例患者（平均年龄 67.12±11.89 岁；男女分布为 139 例（55.8%）和 110 例（44.2%），髋关节/膝关节为 71 例（28.5%）和 178 例（71.5%）。根据 EBJIS 标准，诊断为 PJI 的患者有 54 例（21.7%）。AD 的 AUC 为 0.930（敏感性/特异性为 0.870/0.990），结果极佳。LE 的 AUC 为 0.820（敏感性/特异性为 0.722/0.918），结果非常好。两种参数均显示出很强的正相关。
结论
LE 是 PJI 诊断中一种快速可用的替代方法。同时测定这两种标志物可能会提高诊断的可靠性。常规使用可能会缩短从 PJI 诊断到治疗的时间。
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