Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Front Cell Infect Microbiol. 2024 Apr 30;14:1343338. doi: 10.3389/fcimb.2024.1343338. eCollection 2024.
To investigate the efficacy of serum protein electrophoresis (SPE) in the diagnosis of periprosthetic joint infection (PJI) after hip and knee arthroplasty.
The medical records of patients undergoing hip and knee arthroplasty at a class A tertiary hospital between August 2013 and January 2021 were retrospectively investigated. A total of 179 patients were included and divided into two groups: 66 patients in the PJI group and 113 patients in the aseptic loosening (AL) group. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, Fibrinogen, Serum albumin and the proportion of serum protein in SPE were compared between the two groups. The diagnostic sensitivity and specificity were determined using the receiver operating characteristic (ROC) curve, and the diagnostic value was compared using the area under the ROC curve (AUC).
There was no significant difference in age, sex and body mass index (BMI) between PJI group and AL group (P>0.05), but there was significant difference in the ratio of hip to knee (X22.043, P<0.001). The CRP, ESR, D-dimer, Fibrinogen and the proportion of α1 globulin band in PJI group was 22.99(10.55,40.58) mg/L, 37.00(23.00,61.70) mm/h, 790.00(500.00,1500.00) ng/ml, 4.84(3.81,5.55) g/L and 5.80(5.00,7.73) % which was higher than that in AL group [1.89(0.50,4.12) mg/L, U=7.984, P<0.001; 10.10(7.00,16.90) mm/h, U=8.095, P<0.001; 570.00(372.50,780.00) ng/ml, U=3.448, P<0.001; 2.84(2.45,3.43) g/L, U=8.053, P<0.001 and 4.20(3.90,4.80) %, U=8.154, P<0.001]. The Serum albumin and the proportion of Albumin band in PJI group was 36.10(33.10,39.00) g/L and 49.00(44.95,52.20) % which was lower than that in AL group [38.10(34.00,41.10) g/L, U=-2.383, P=0.017 and 54.40(51.55,56.70) %, U=-6.162, P<0.001]. The proportion of In PJI group, the AUC of proportion of α1 globulin was 0.8654, which was equivalent to CRP (0.8698), ESR (0.8680) and outperformed that of fibrinogen (0.8025).
Elevated proportion of α1 globulin in SPE presented with good diagnostic value for Tsukayama type IV PJI, and its accuracy was comparable to those of ESR and CRP. And α1 globulin can assist with CRP and ESR to determining the timing of second-stage revision.
探讨血清蛋白电泳(SPE)在髋关节和膝关节置换术后假体周围关节感染(PJI)诊断中的作用。
回顾性分析 2013 年 8 月至 2021 年 1 月期间在一家 A 级三甲医院接受髋关节和膝关节置换术的患者的病历。共纳入 179 例患者,分为 PJI 组(66 例)和无菌性松动(AL)组(113 例)。比较两组患者的 C 反应蛋白(CRP)、红细胞沉降率(ESR)、D-二聚体、纤维蛋白原、血清白蛋白和 SPE 中血清蛋白的比例。采用受试者工作特征(ROC)曲线确定诊断的敏感性和特异性,并采用 ROC 曲线下面积(AUC)比较诊断价值。
PJI 组和 AL 组患者的年龄、性别和体重指数(BMI)无显著差异(P>0.05),但髋关节与膝关节的比例有显著差异(X2=22.043,P<0.001)。PJI 组的 CRP、ESR、D-二聚体、纤维蛋白原和α1 球蛋白带比例分别为 22.99(10.55,40.58)mg/L、37.00(23.00,61.70)mm/h、790.00(500.00,1500.00)ng/ml、4.84(3.81,5.55)g/L 和 5.80(5.00,7.73)%,均高于 AL 组[1.89(0.50,4.12)mg/L,U=7.984,P<0.001;10.10(7.00,16.90)mm/h,U=8.095,P<0.001;570.00(372.50,780.00)ng/ml,U=3.448,P<0.001;2.84(2.45,3.43)g/L,U=8.053,P<0.001 和 4.20(3.90,4.80)%,U=8.154,P<0.001]。PJI 组的血清白蛋白和白蛋白带比例分别为 36.10(33.10,39.00)g/L 和 49.00(44.95,52.20)%,低于 AL 组[38.10(34.00,41.10)g/L,U=-2.383,P=0.017 和 54.40(51.55,56.70)%,U=-6.162,P<0.001]。在 PJI 组中,α1 球蛋白比例的 AUC 为 0.8654,与 CRP(0.8698)、ESR(0.8680)相当,优于纤维蛋白原(0.8025)。
SPE 中α1 球蛋白比例升高对 Tsukayama Ⅳ型 PJI 具有良好的诊断价值,其准确性与 ESR 和 CRP 相当。α1 球蛋白可以与 CRP 和 ESR 联合确定二期翻修的时机。