Baek Yae Jee, Lee Youn-Jung, Lee Jung Ah, Kim Jung Ho, Kwon Hyuck Min, Yeom Joon-Sup, Park Kwan Kyu, Jeong Su Jin
Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul 04401, Republic of Korea.
Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2023 Sep 14;12(18):5964. doi: 10.3390/jcm12185964.
The utility of α-defensin (AD), leukocyte esterase (LE) levels, and metagenomics sequencing as diagnostic tools for prosthetic joint infection (PJI) has been suggested, but there are few studies among the Asian population. This study aimed to evaluate the diagnostic performance of various biomarkers for PJI and the role of the microbiome in the synovial fluid of patients with prostheses. Patients with suspected knee PJI were enrolled, and their blood and synovial fluid were collected. The cases were classified into the PJI and non-PJI groups. Significant differences between the two groups were observed in the levels of AD (4698 µg/L vs. 296 µg/L, < 0.001) and positivity for LE (62.5% vs. 21.1%, = 0.01). AD had 94.4% sensitivity and 89.5% specificity for diagnosing PJI, whereas LE had 37.5% sensitivity and 100% specificity. Microbiome taxonomic profiling showed high sensitivity. The number of operational taxonomic units and the richness of the microbiome in the synovial fluid were higher in the non-PJI than in the PJI group. AD has shown encouraging results in the Asian population as a diagnostic biomarker for PJI, and LE can be used as a diagnostic adjunct. The bacterial richness of the synovial fluid is likely associated with infections.
α-防御素（AD）、白细胞酯酶（LE）水平以及宏基因组测序作为人工关节感染（PJI）诊断工具的效用已被提及，但在亚洲人群中的研究较少。本研究旨在评估各种生物标志物对PJI的诊断性能以及微生物群在假体患者滑液中的作用。纳入疑似膝关节PJI患者，采集其血液和滑液。病例分为PJI组和非PJI组。两组之间在AD水平（4698µg/L对296µg/L，<0.001）和LE阳性率（62.5%对21.1%，=0.01）方面观察到显著差异。AD诊断PJI的敏感性为94.4%，特异性为89.5%，而LE的敏感性为37.5%，特异性为100%。微生物群分类分析显示出高敏感性。非PJI组滑液中的可操作分类单元数量和微生物群丰富度高于PJI组。AD作为PJI的诊断生物标志物在亚洲人群中已显示出令人鼓舞的结果，LE可作为诊断辅助手段。滑液中的细菌丰富度可能与感染有关。
