Jeng G W, Wang C R, Liu S T, Su C C, Tsai R T, Yeh T S, Wen C L, Wu Y Q, Lin C Y, Lee G L, Chen M Y, Liu M F, Chuang C Y, Chen C Y
Department of Internal Medicine, National Taiwan University Hospital, ROC.
Am J Emerg Med. 1997 Nov;15(7):626-9. doi: 10.1016/s0735-6757(97)90173-x.
Because of the high morbidity and mortality in patients with bacterial arthritis, rapidly and correctly diagnosing this critical condition is a challenge to emergency clinicians. Synovial fluid samples were obtained from 75 patients with arthritis disorders who presented to an emergency service, and levels of tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), and interleukin-6 (IL-6) were measured. Twenty patients with culture-proven bacterial arthritis had higher levels of synovial TNF-alpha than patients with osteoarthritis or with inflammatory arthritis, including gouty arthritis, rheumatoid arthritis, reactive arthritis, and lupus arthritis. There was a good sensitivity for synovial TNF-alpha level in diagnosing patients with bacterial arthritis. Nearly 100% of patients with bacterial arthritis had elevated synovial TNF-alpha levels. However, synovial IL-1 beta and IL-6 levels failed to discriminate bacterial arthritis from other inflammatory arthritis. Measurement of synovial TNF-alpha level may be useful as a diagnostic aid in emergency patients with bacterial arthritis disorders.
由于细菌性关节炎患者的发病率和死亡率较高，快速、准确地诊断这种危急病症对急诊临床医生来说是一项挑战。从75名到急诊就诊的关节炎患者中获取了滑液样本，并测量了肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-6（IL-6）的水平。20名经培养证实为细菌性关节炎的患者，其滑液TNF-α水平高于骨关节炎患者或包括痛风性关节炎、类风湿性关节炎、反应性关节炎和狼疮性关节炎在内的炎性关节炎患者。滑液TNF-α水平对诊断细菌性关节炎患者具有良好的敏感性。几乎100%的细菌性关节炎患者滑液TNF-α水平升高。然而，滑液IL-1β和IL-6水平无法区分细菌性关节炎和其他炎性关节炎。测量滑液TNF-α水平可能有助于诊断患有细菌性关节炎病症的急诊患者。
