关节液中细菌16srRNA与23s rRNA诊断膝关节置换术后感染的价值

Value of bacterial 16s rRNA and 23s rRNA in the diagnosis of infection after total knee arthroplasty

目的探讨利用关节液中细菌16s rRNA与23s rRNA诊断全膝关节置换术后感染的效率及两种基因诊断方法的差异。方法对33例无菌性松动及19例假体周围感染行人工膝关节翻修的患者,通过RT-PCR检测关节液中细菌16s rRNA、23s rRNA保守基因片段诊断假体周围感染。比较两种诊断策略的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果以国外关于假体周围感染诊断方法的文献判定假体周围感染,利用16s rRNA进行诊断的敏感性78.8%,特异性93.9%,阳性预测值88.2%,阴性预测值为88.6%,准确性为88.5%;而采用23s rRNA扩增方法诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为68.4%、78.8%、65.0%、81.2%和75.0%。两种基因诊断的各指标比较差异均无统计学意义(P>0.05)。结论通过检测关节液中细菌16s rRNA或23s rRNA诊断人工膝关节置换术后感染,具有较高的诊断效率,且两者差异无统计学意义。

Objective To explore the power of detecting bacteria 16s rRNA and 23s rRNA to diagnose periprostbetic joint infection （PJI） after total knee arthroplasty （TKA）. Methods A prospective study of 52 patients who had a TKA and were undergoing a reoperation because of infection （19 patients） or aseptic loosening （33 patients） was conducted. The 16S rRNA and 23S rRNA in joint fluid were detected by RT-PCR as a marker to diagnose PJI. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were compared. Results The diagnose power of 16s rRNA was higher than 23s rRNA： sensitivity （78.8% vs 68.4%）, specificity （93.9% vs 78.8%）, positive predictive value （88.2% vs 65.0%）, negative predictive value （88.6% vs 81.2%） and accuracy （88.5% vs 75.0%）. However, all of those difference was not statistically significant （P〉0. 05）. Conclusion Both 16s rRNA and 23s rRNA have satisfactory diagnosis power of to detect PJI, and there was no difference.