血清D-二聚体在关节假体周围感染诊断中的意义

Significance of serum D-dimer in the diagnosis of prosthetic joint infection

[目的]探讨血清D-二聚体在关节假体周围感染(prosthetic joint infection,PJI)诊断中的意义。[方法]回顾性分析本科2016年6月~2018年6月收治的80例患者,其中初次置换组33例,PJI分期翻修24例,无菌松动翻修术组23例。比较三组患者术前血清C-反应蛋白(CRP)、血沉(ESR)、D-二聚体等数据。[结果]三组患者一般资料比较差异无统计学意义(P>0.05)。PJI患者血清CRP、ESR水平显著高于初次关节置换及无菌性松动患者(P<0.05),PJI患者血清D-二聚体水平显著高于初次置换者(P<0.05),但与无菌性松动患者体内D-二聚体水平差异不具有统计学意义(P>0.05)。当以D-二聚体>0.85μg/L为PJI诊断标准时,血清CRP、ESR、D-二聚体诊断PJI的敏感性、特异性类似,差异无统计学意义(P>0.05)。当以D-二聚体>0.5μg/L为PJI诊断标准时,D-二聚体诊断PJI的敏感性与CRP及ESR类似(P>0.05),但特异性差于CRP及ESR,差异具有统计学意义(P<0.05)。[结论]与CRP、ESR相比,血清D-二聚体在PJI诊断中无明显优势。

[Objective]To explore the significance of serum D-Dimer in the diagnosis of prosthetic joint infection(PJI).[Methods]A retrospective study was conducted on 80 patients,including 33 patients who underwent primary total knee arthroplasty(TKA)for osteoarthritis,24 patients who received first stage of revision for PJI,and 23 patients who had definitive revision surgery for aseptic prosthetic loosening.The serum levels of C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and D-dimer before operation were compared among the three groups.[Results]There were no statistically significant difference among the three groups in general data,such as gender and age(P>0.05).The serum levels of CRP and ESR in the PJI group proved significantly higher than the primary TKA group and the loosening group(P<0.05).Although serum D-Dimer level in the PJI group was proved significantly higher than the primary TKA group(P<0.05),it was not significantly different between the PJI group and the loosening(P>0.05).As the diagnosis criteria set at D-dimer>0.85μg/L,the sensitivity and specificity for diagnosis of PJI were not significantly different among CRP,ESR and D-dime.By contrast,as the diagnosis criteria set at D-dimer>0.05μg/L,the sensitivity for diagnosis of PJI were not significantly different among CRP,ESR and D-dime(P>0.05),while the specificity of the D-dimer for diagnosis of PJI proved significantly inferior to the CPR and ESR(P<0.05).[Conclusion]The serum D-dimer does not take any advantage over the CRP and ESR for diagnosis of PJI.