D-二聚体对髋、膝关节置换术后慢性假体周围感染诊断价值的研究

Diagnostic value of D-dimer for chronic periprosthetic infection after hip and knee joint replacement

目的探讨D-二聚体对髋、膝关节置换术后慢性假体周围感染(PJI)的诊断价值。方法回顾性分析2017年11月至2018年12月在新疆医科大学第一附属医院行髋、膝关节置换或翻修术的168例患者的临床资料。男性58例,女性110例,年龄(58.6±14.5)岁。其中慢性PJI患者48例(膝关节21例、髋关节27例),无菌性松动患者57例(膝关节16例、髋关节41例),正常随访患者63例(膝关节28例、髋关节35例)。收集患者血D-二聚体、红细胞沉降率(ESR)和C-反应蛋白(CRP)水平。采用Mann-Whitney U检验比较髋、膝关节慢性PJI患者的D-二聚体水平,采用受试者工作曲线(ROC)分析D-二聚体、ESR、CRP诊断髋关节和膝关节慢性PJI的诊断效力。结果慢性PJI组膝关节D-二聚体水平[M(QR)]为1040(1140.5)μg/L,高于慢性髋关节PJI患者的435(605)μg/L(Z=3.169,P=0.002),差异有统计学意义。ROC曲线分析结果显示,诊断膝关节慢性PJI的D-二聚体最佳截断值为370.5μg/L,灵敏度为90.5%、特异度为84.1%;CRP最佳截断值为9.3 mg/L,灵敏度为95.2%、特异度为90.9%,ESR最佳截断值为33 mm/h,灵敏度为90.5%、特异度为88.6%。诊断髋关节慢性PJI的D-二聚体最佳截断值为294μg/L,诊断的灵敏度为66.7%,特异度为77.6%;ESR最佳截断值为45 mm/h,诊断的灵敏度为55.6%,特异度为97.4%;CRP最佳截断值为8.1 mg/L,诊断的灵敏度为74.1%,特异度为84.2%。结论D-二聚体对膝关节慢性PJI的诊断价值要高于髋关节慢性PJI,但D-二聚体诊断膝、髋关节慢性PJI的价值不优于ESR、CRP。

Objective To investigate the diagnose value of D-dimer for chronic periprosthetic infection(PJI)after hip and knee arthroplasty.Methods A retrospective analyze was conducted on 168 patients underwent revision arthroplasty and primary arthroplasty at the First Affiliated Hospital of Xinjiang Medical University from November 2017 to December 2018.There were 58 males and 110 females,aged(58.6±14.5)years.There were 48 cases of chronic PJI(21 cases of knee joint,27 cases of hip joint),57 cases of aseptic loosening(16 cases of knee joint,41 cases of hip joint),and 63 cases of normal follow-up patients after hip(35 cases)or knee(28 cases)arthroplasty.The levels of D-dimer,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were collected.The levels of D-dimer in patients with chronic PJI of hip and knee joints were compared by Mann-Whitney U test.The diagnostic efficacy of D-dimer,ESR and CRP in chronic PJI of hip and knee joints was analyzed by receiver operator curve(ROC).Results The D-dimer level was significantly higher in knee chronic PJI patients than hip chronic PJI patients(M(QR))(1040(1140.5)μg/L vs.435(605)μg/L,Z=3.169,P=0.002).ROC analysis showed that the optimum cutoff value of D-dimer in the diagnosis of chronic PJI was 370.5μg/L,the sensitivity was 90.5%,the specificity was 84.1%;the optimum cutoff value of CRP was 9.3 mg/L,the sensitivity was 95.2%,the specificity was 90.9%,the optimum cutoff value of ESR was 33 mm/h,the sensitivity was 90.5%,and the specificity was 88.6%.The optimum cutoff value of D-dimer in the diagnosis of chronic PJI of hip joint is 294μg/L,the sensitivity of diagnosis is 66.7%,the specificity is 77.6%;the optimum cutoff value of ESR is 45 mm/h,the sensitivity of diagnosis is 55.6%,the specificity is 97.4%;the optimum cutoff value of CRP is 8.1 mg/L,the sensitivity of diagnosis is 74.1%,the specificity is 84.2%.Conclusion The value of D-dimer in the diagnosis of chronic PJI of knee joint is higher than that of hip joint,but the value of D-dimer in the diagnosis of chronic PJI is not better than ESR and CRP.