三个假体周围感染诊断国外标准在中国人群效能比较（开放获取）

Efficient comparison of three foreign diagnostic criteria for periprosthetic joint infection in Chinese population

摘要:

[目的] 比较欧洲骨关节感染学会（European Bone and Joint Infection Society, EBJIS） 2021、国际共识会议（Interna-tional Consensus Meeting, ICM） 2018 和美国传染病学会（Infectious Diseases Society, IDSA） 2013 三种假体周围感染（periprosthet-ic joint infection, PJI） 诊断标准在中国人群的诊断效能。[方法] 回顾性分析2017 年1 月—2019 年11 月在解放军总医院第四医学中心接受关节置换术后感染治疗的140 例患者的临床资料，收集相关数据，分别按照三种诊断标准进行PJI 诊断，对均满足三个诊断标准的患者与满足部分诊断标准的患者数据进行比对及分析。[结果] 在140 例患者中，符合IDSA2013 标准135 例（96.4%），符合ICM2018 标准127 例（90.7%），符合EBJIS2021 标准133 例（95.0%），三个标准诊断效能差异无统计学意义（P＞0.05）。122 例（87.1%） 符合三种诊断标准，18 例（12.9%） 符合其中一种或两种诊断标准。满足三个标准组患者存在窦道[例,无/有, (79/43) vs (18/0)，P=0.002]、术中见脓[例, 无/有, (85/37) vs (17/1)，P=0.027]、不同部位培养阳性[例, 否/是, (38/84) vs (18/0),P＜0.001] 的比率显著高于至多两个标准组。满足三个标准组患者CRP [mg/dl, M (P25, P75), 1.95 (0.55, 3.81) vs 0.95 (0.1, 2.58), P=0.030]、关节液白细胞计数[细胞/μl, M (P25, P75), 11 970 (2 126.5, 24 900) vs 300 (32, 5 498), P=0.021] 显著高于至多两个标准组。[结论] EBJIS2021 的PJI 诊断标准与IDSA2013 及ICM2018 的标准具有相似的诊断效能，但是，三种诊断标准对于全身炎症反应或局部症状较轻的PJI 患者诊断存在分歧。

Abstract:

[Objective] To compare diagnostic efficacy of three foreign diagnostic criteria for periprosthetic joint infection (PJI), includ-ing the European Bone and Joint Infection Society (EBJIS 2021), the International Consensus Meeting (ICM 2018) and Infectious DiseasesSociety of America (IDSA 2013) in the Chinese population. [Methods] A retrospective study was conducted on 140 patients who receivedtreatment for PJI in The Fourth Medical Center of the PLA General Hospital from January 2017 to November 2019. The data related to PJI di-agnosed respectively according to three foreign diagnostic criteria was collected. The documents of patients who met all three diagnostic crite-ria and those who met part of the diagnostic criteria were compared and analyzed. [Results] Among the 140 patients, 135 patients (96.4%)met the criteria of IDSA2013, 127 patients (90.7%) met the criteria of ICM2018, and 133 patients (95.0%) met the criteria of EBJIS2021,and there was no statistically significant difference in diagnostic efficacy among the three criteria (P＞0.05). Of them, 122 cases (87.1%) metall the three diagnostic criteria, whereas 18 cases (12.9%) met one or two of the diagnostic criteria. The patients meeting all the three criteriaproved significantly higher than those meeting ≤2 criteria in terms of local sinus [cases, No/Yes, (79/43) vs (18/0), P=0.002], intraoperativepus [cases, No/Yes, (85/37) vs (17/1), P=0.027], ratio of positive culture in different sites [cases, No/Yes, (38/84) vs (18/0), P＜0.001]. In addi-tion, the former had significantly higher CRP [mg/dl, M (P25, P75), 1.95 (0.55, 3.81) vs 0.95 (0.1, 2.58), P=0.030] and the joint fluid leuko-cyte count [cells/μl, M (P25, P75), 11 970 (2 126.5, 24 900) vs 300 (32, 5 498), P=0.021] than the latter. [Conclusion] PJI diagnostic criteriaof EBJIS2021 have similar diagnostic efficacy to those of IDSA2013 and ICM2018. However, the three diagnostic criteria are different in thediagnosis of PJI with mild systemic inflammatory response or local symptoms.