不同检验指标诊断关节假体周围感染的意义△

Significance of blood test parameters in the diagnosis of periprosthetic joint infection

摘要:

[目的] 探讨白蛋白与纤维蛋白原比率 （albumin/fibrinogen ratio, AFR）、C 反应蛋白/（白蛋白/球蛋白） 比率 （CRP/ albumin/globulin ratio, CAGR） 和白蛋白 （albumin, ALB） 对人工关节置换术后关节假体周围感染 （periprosthetic joint infection, PJI） 的诊断价值。[方法] 回顾性分析 2018 年 1 月—2021 年 1 月在本院行髋、膝关节翻修术的 95 例患者的临床资料。其中 45 例诊断为 PJI，50 例诊断为假体无菌性松动 （aseptic loosening, AL）。统计分析两组检验指标，以 ROC 曲线计算各项指标的灵敏度与特异度，并依据曲线下面积比较其诊断效能。[结果]PJI 组的 CRP [(42.2±47.4) mg/L vs (8.8±18.4) mg/L, P＜0.05]、ESR [(54.2±27.7) mm/h vs (22.2±18.7) mm/h, P＜0.05]、FIB [(5.1±1.4) g/L vs (3.4±0.8) g/L, P＜0.05]、GLO [(32.1±6.3) g/L vs (27.4±4.5) g/L, P＜ 0.05] 和 CAGR [(39.6±43.6) vs (6.6±14.8) , P＜0.05] 水平均显著高于 AL 组，而 ALB [(37.0±7.4) g/L vs (40.7±4.1) g/L, P＜0.05] 和 AFR [(7.9±3.1) vs (12.9±3.3), P＜0.05] 均显著低于 AL 组 （P＜0.05）。ROC 分析表明，FIB （AUC=0.869、灵敏度=82.0%、特异度= 80.0%）、AFR （AUC=0.864、灵敏度=92.0%、特异度=80.0%）、CAGR （AUC=0.825、灵敏度=90.0%、特异度=66.7%）、GLO （AUC=0.768、灵敏度=54.0%、特异度=91.1%）诊断 PJI 的价值均为良，而 ALB 价值为一般（AUC=0.754、灵敏度=86.0%、特异度=60.0%）。[结论]AFR、FIB 和 CAGR 可作为 PJI 诊断的新辅助指标。

Abstract:

[Objective] To explore the significances of albumin/fibrinogen ratio (AFR), C- reactive protein/ (albumin/globulin) ratio (CAGR) and albumin (ALB) in the diagnosis of periprosthetic joint infection (PJI) secondary to major joint replacement. [Methods] A retro- spective study was done on 95 patients who underwent revision of hip or knee arthroplasty in our hospital from January 2018 to January 2021. Of them, 45 patients were definitively diagnosed of PJI, while the remaining 50 patients were definitively diagnosed of aseptic loosening (AL). The blood test parameters were compared between the two groups, then which were analyzed by ROC curve to calculate the sensitivity and specificity, and the diagnostic efficacy by area under curve (AUC). [Results] The PJI group had significantly higher level of CRP [(42.2±47.4) mg/L vs (8.8±18.4) mg/L, P＜0.05], ESR [(54.2±27.7) mm/h vs (22.2±18.7) mm/h, P＜0.05], FIB [(5.1±1.4) g/L vs (3.4±0.8) g/L, P＜0.05], GLO [(32.1±6.3) g/L vs (27.4±4.5) g/L, P＜0.05] and CAGR [(39.6±43.6) vs (6.6±14.8), P＜0.05], while significantly lower level of ALB [(37.0±7.4) g/ L vs (40.7±4.1) g/L, P＜0.05] and AFR [(7.9±3.1) vs (12.9±3.3), P＜0.05] than the AL group. As results of ROC analysis, the FIB (AUC=0.869, sensitivity=82.0%, specificity=80.0%) , the AFR (AUC=0.864, sensitivity=92.0%, specificity=80.0%), the CAGR (AUC=0.825, sensitivity= 90.0% , specificity=66.7% ), and the GLO was good (AUC=0.768, sensitivity=54.0% , specificity=91.1% ), while the ALB was fair (AUC= 0.754, sensitivity=86.0%, specificity=60.0%). [Conclusion] AFR, FIB and CAGR might be used as new auxiliary marker for PJI diagnosis.