关节置换术后假体周围感染诊断的研究进展

Progress in diagnosis of periprosthetic joint infection after arthroplasty

假体周围感染(PJI)是人工关节置换术后患者的灾难性并发症之一,已经成为关节置换术后翻修的首要原因,目前的实验室和影像学诊断方法各有优缺点,PJI的诊断仍缺乏金标准。红细胞沉降率、C反应蛋白等传统诊断学方法敏感度和特异度不高;白细胞酯酶测定、α-防御素等关节液标记物具有极高的诊断价值,引起越来越多的重视;与血清中相比,关节液中的降钙素原和白细胞介素-6对诊断PJI更具价值;白细胞闪烁扫描、抗粒细胞闪烁扫描和^(18)氟-氟脱氧葡萄糖等影像学技术具有较高的敏感度和特异度,但目前尚无法大规模应用;而二代测序等分子生物学技术能检测到常规细菌培养阴性的病原菌DNA,且不受抗生素使用与否的影响,已成为目前研究的热点。本综述旨在提供更具敏感度和特异度的诊断方法,使人工关节置换术后假体周围感染的患者能够早诊断、早治疗,从而减轻病人的痛苦和降低医疗费用。

Periprosthetic joint infection(PJI)is one of the catastrophic complications of patients undergoing joint replacement and has become the primary cause of joint replacement revision surgery.At present,diagnosis of PJI still lacks golden standard because of the limited sensitivity and specificity of laboratory and imaging diagnostic methods,such as erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP).Synovial fluid biomarkers such as leukocyte esterase and alpha-defensins have extremely high diagnostic utility and have attracted increasing attention.The concentration of procalcition and IL-6 in joint fluid has higher diagnostic value than that in serum.Leukocyte scintigraphy,anti-granulocyte scintigraphy and 18 fluoro-fluorodeoxyglucose imaging techniques perform well but they are still not widely applied.Molecular biology techniques such as second-generation sequencing have become the focus of current research due to the ability to detect DNA in culture-negative pathogens and being unaffected by previous antibiotics administration.This article aims to provide more sensitive and specific diagnostic methods to get early diagnosis and early treatment for patients with PJI,so as to reduce patients′pain and costs.