关节假体周围感染检测滑液D-二聚体等的意义△（开放获取）

Significance of detecting D-dimer of synovial fluid in periprosthetic joint infection

摘要:

[目的] 探讨关节液 D-二聚体 （synovial D-Dimer, D-D）、纤维蛋白原降解产物 （synovial fibrin degradation product, sFDP）在关节假体周围感染（prosthetic joint infection, PJI）诊断中的意义。[方法]回顾性分析本科 2020 年 3 月-2023 年 6 月收治的 49 例 PJI 患者 （PJI 组） 及 32 例无菌性假体松动 （aseptic prosthesis loosening, APL） 患者 （APL 组） 的临床资料，使用接收者操作特征曲线对各项指标在 PJI 诊断中的曲线下面积 （area under curve, AUC）、最佳截断值、敏感性及特异性进行分析。采用 Delong et al. （1988） 的统计方法对各项指标在 PJI 诊断中的 ROC 结果进行两两比较。[结果] PJI 组的 WBC [(6.8± 2.1)×10⁹ /L vs (5.8±1.6)×10⁹ /L, P=0.026]、中性粒细胞比值 [(63.8±8.2)% vs (55.5±13.0)%, P＜0.001]、C-反应蛋白 （C-reactive Pro- tein, CRP） [(29.8±35.6) mg/L vs (1.7±2.6) mg/L, P＜0.001]、血沉 （erythrocyte sedimentation rate, ESR） [(63.4±32.5) mm/h vs (16.2± 14.6) mm/h, P＜0.001]、纤维蛋白原（fibrinogen, FIB）[(4.8±1.5) g/L vs (2.8±0.7) g/L, P＜0.001]、D-二聚体（D-dimer, D-D）[(961.3± 639.4) μg/mL vs (385.2±429.4) μg/mL, P＜0.001] 和可溶性纤维蛋白原 （soluble fibrinogen, sFDP） [(3 514.3±2 030.7) mg/L vs (1 222.0±1 352.6) mg/L, P＜0.001] 水平均显著高于 APL 组。ROC 分析表明，CRP（AUC=0.924、灵敏度=87.80%、特异度=84.40%）、 ESR （AUC=0.913、灵敏度=85.40%、特异度=81.30%）、FIB （AUC=0.892、灵敏度=73.50%、特异度=96.90%）、sFDP （AUC= 0.875、灵敏度=71.40%、特异度=90.60%） 诊断 PJI 的价值均为良，而 D-D 价值为一般（AUC=0.809、灵敏度=65.30%、特异度 =84.40%）。[结论]sFDP 可作为 PJI 诊断的新辅助指标。

Abstract:

[Objective] To investigate the significance of synovial D-Dimer (D-D) and synovial fibrin degradation product (sFDP) in the diagnosis of periprosthetic joint infection (PJI). [Methods] A retrospective study was conducted on 49 patients with PJI (the PJI group) and 32 patients with aseptic prosthesis loosening (the APL group) in our hospital from March 2020 to June 2023. The receiver operating characteristic curve was used to analyze the area under curve (AUC), optimal cutoff value, sensitivity and specificity of each parameter for PJI diagnosis. The statistical method of Delong et al. (1988) was used to compare the ROC results of each item in PJI diagnosis. [Results] The PJI group proved significantly higher than the APL group in terms of WBC [(6.8±2.1)×10⁹ /L vs (5.8±1.6)×10⁹ /L, P=0.026], neutrophils ratio [(63.8±8.2)% vs (55.5±13.0)%, P＜0.001], C-reactive protein (CRP) [(29.8±35.6) mg/L vs (1.7±2.6) mg/L, P＜0.001], erythrocyte sedimentation rate (ESR) [(63.4±32.5) mm/h vs (16.2±14.6) mm/h, P＜0.001], fibrinogen, FIB) [(4.8±1.5) g/L vs (2.8±0.7) g/L, P＜0.001], D-dimer (D-D) [(961.3±639.4) g/L vs (385.2±429.4) g/L, P＜0.001], sFDP [(3 514.3±2 030.7) mg/L vs (1 222.0±1 352.6) mg/L, P＜0.001]. As results of ROC analysis, the CRP (AUC=0.924, sensitivity=87.8%, specificity=84.4%), ESR (AUC=0.913, sensitivity=85.4%, specificity= 81.3%), FIB (AUC=0.892, sensitivity=73.5%, specificity=96.9%), sFDP (AUC=0.875, sensitivity=71.4%, specificity=90.6%) showed good value in the diagnosis of PJI, while D-D value was average (AUC=0.809, sensitivity=65.3%, specificity=84.4%). [Conclusion] sFDP can be used as a new auxiliary parameter in the diagnosis of PJI.