血清CRP联合滑液CRP辅助诊断关节假体周围感染的价值分析

Value Serum CRP Combined with Synovial CRP in the Diagnosis of Periprosthetic Joint Infection

目的探讨血清CRP联合关节滑液CRP在关节置换术后假体周围感染诊断中的应用价值.方法回顾性分析2015年9月~2018年11月在武汉大学人民医院进行关节置换翻修术的患者资料,建立病例纳入和排除标准,术前进行血清CRP、ESH、白细胞计数等血清学炎性指标检测,术前行关节穿刺或术中切开获取关节液进行滑液CRP、白细胞计数、多形核中性粒细胞计数检测,并进行微生物培养等.以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为“金标准”,分析血清CRP与滑液CRP单独及联合在假体周围感染中的诊断价值.结果84例患者被纳入研究,26例被确诊为假体周围感染,为感染组,58例被排除感染,为非感染组.两者联合检测的敏感度、特异性、准确性分别为92.30%、89.66%、90.48%,单纯血清CRP检测的敏感度、特异性、准确性分别为73.08%、60.34%、64.29%,单纯滑液CRP检测的敏感度、特异性、准确性分别为88.46%、74.13%、78.57%.联合检测的敏感度、特异性、准确性均高于单纯血清CRP或单纯滑液CRP检测,差异有统计学意义(P<0.05).结论血清CRP联合滑液CRP检测可显著提高假体周围感染诊断的正确性,适宜应用于临床.

Objective To investigate the value of serum CRP combined with synovial CRP in the diagnosis of periprosthetic infection after joint replacement.Methods The data of patients undergoing revision arthroplasties in Renmin Hospital of Wuhan University from September 2015 to November 2018 were retrospectively analyzed.Inclusion and exclusion criteria were established.Serological tests were performed preoperatively and synovial inflammatory markers and bacterial culture were performed preoperatively or intraoperatively.The diagnostic standard of periprosthetic joint infection established by the American association of muscle and skeletal muscle infection(MSIS)was used as the"gold standard"to analyze the diagnostic value of serum CRP and synovial CRP alone and in combination in periprosthetic joint infection.Results Of the 84 patients included in the study,26 were diagnosed with periprosthetic joint infection,in the infected group,and 58 were excluded from infection,in the non—infected group.The sensitivity,specificity and accuracy of combined detection were 92.30%,89.66% and 90.48%,respectively.The sensitivity,specificity and accuracy of pure serum CRP detection were 73.08%,60.34% and 64.29%,respectively.The sensitivity,specificity and accuracy of pure synovial CRP detection were 88.46%,74.13% and 78.57%,respectively.The sensitivity,specificity and accuracy of combined detection were higher than that of serum CRP alone or synovial CRP alone,and the difference was statistically significant(P<0.05).Conclusion Serum CRP combined with synovial CRP can significantly improve the diagnostic accuracy of periprosthetic joint infection and can be used in clinical practice.