血清学炎性因子在假体周围感染中的应用

Application of serum inflammatory factors in periprosthetic joint infection

目的通过检测由于各种原因接受关节翻修手术患者血清中C-反应蛋白(CRP)、动态红细胞沉降率(ESR)、超敏C-反应蛋白(hs-CRP)及白细胞介素-6(IL-6),探讨其在诊断假体周围感染中的临床意义与诊断价值。方法选取2013年8月至2016年8月于北京大学人民医院骨关节科接受关节翻修手术的患者160例,符合美国肌肉与骨骼肌感染协会(MSIS)制定的假体周围感染诊断标准的患者为感染组,不符合者为非感染组,测量患者的血清中CRP、ESR、hs-CRP及IL-6水平,并通过受试者工作特征曲线-曲线下面积(ROC-AUC)分析评估各指标诊断假体周围感染的临床意义与价值。结果血清学炎性指标CRP、ESR、hs-CRP及IL-6水平感染组较非感染组高(P<0.01),其AUC值为0.89(95%CI:0.83,0.94)、0.88(95%CI:0.82,0.93)、0.90(95%CI:0.84,0.95)及0.92(95%CI:0.89,0.96)。各指标之间无明显统计学差异。IL-6与CRP或hs-CRP平行试验联合诊断PJI敏感性高(敏感性分别为100.0%(93.9%,100.0%)和98.3%(90.9%,100.0%)),具有很好的应用价值。结论 CRP、ESR、hs-CRP和IL-6对于假体周围感染具有明确的诊断意义,其中IL-6的诊断价值可能更高。联合诊断能提高假体周围感染诊断的敏感性或者特异性。CRP与IL-6联合或者hs-CRP与IL-6联合对于排除假体周围感染临床意义更大。

Objective To test the C-reactive protein（ CRP）,erythrocyte sedimentation rate（ ESR）,high sensitive C-reactive protein（ hs-CRP） and interleukin-6（ IL-6） in patients for various reasons to accept total joint revision to explore their clinical significance and diagnostic value in the diagnosis of periprosthetic joint infection. Methods A total of 160 patients were selected from August2013 to August 2016 in Peking University People＇s Hospital to accept joint revision surgery. Patients meet the criteria of PJI from the muscle and skeletal muscle Association（ MSIS） are divided to the infection group,others are the non-infection group. The levels of CRP,ESR,and hs-CRP and IL-6 were tested,and to evaluate the clinical significance for the diagnosis of periprosthetic joint infection by receiver operating characteristic curve-area under curve（ ROC-AUC） analysis. Results The levels of CRP,ESR,hs-CRP and IL-6 in infection group were higher than ono-infection group（ P 0. 01）,and the AUC of CRP,ESR,hs-CRP and IL-6 were 0. 89（ 95% CI： 0. 83,0. 94） 、0. 88（ 95% CI： 0. 82,0. 93） 、0. 90（ 95%CI： 0. 84,0. 95） and 0. 92（ 95% CI： 0. 89,0. 96） respectively. No statistic difference was found among CRP,ESR,hs-CRP and IL-6. Conclusions CRP,ESR,hs-CRP and IL-6 have a definite diagnostic value for the infection of the prosthesis. The combination of CRP and hs-CRP or IL-6 and IL-6 is more significant for the exclusion of the PJI.