D-二聚体诊断髋关节置换后慢性假体周围感染的敏感性和特异性

Sensitivity and specificity of D-dimer in the diagnosis of chronic periprosthetic infection after hip replacement

背景:目前慢性髋关节假体周围关节感染的诊断尚缺乏有效特异性的指标,研究发现D-二聚体水平在炎症疾病中会升高,因此D-二聚体可能成为诊断慢性髋关节假体周围关节感染有价值的生物标志物。目的:观察D-二聚体检测慢性髋关节假体周围关节感染的敏感性和特异性,以提高慢性髋关节假体周围关节感染诊断的准确性。方法:回顾性分析广州中医药大学第一附属医院2010至2018年收治的髋关节翻修病例,根据诊断标准分为无菌性松动组(n=83)和慢性假体周围感染组(n=61)。术前3 d测定D-二聚体、降钙素原、C-反应蛋白、红细胞沉降率(血沉)和白细胞总数,对比两组之间的差异,并通过受试者工作特征曲线和曲线下面积分析诊断的准确性。结果与结论:(1)慢性假体周围感染组的D-二聚体、降钙素原、C-反应蛋白、血沉和白细胞总数均高于无菌性松动组,差异有显著性意义(P<0.001);(2)D-二聚体曲线下面积为0.898,比降钙素原(0.816)、红细胞沉降率(0.773)、C-反应蛋白(0.708)和白细胞总数(0.669)都要更准确,差异有显著性意义(P<0.001);(3)D-二聚体的最佳截断值为1470.5μg/L,诊断慢性髋关节假体周围关节感染的敏感性为83.6%,特异性为89.2%;(4)提示D-二聚体在慢性髋关节假体周围感染中的诊断价值优于其他炎性指标(降钙素原、C-反应蛋白、血沉和白细胞总数),D-二聚体与其他炎性指标联用有利于早期诊断慢性髋关节假体周围感染及评估病情。

BACKGROUND:At present,the diagnosis of chronic hip joint prosthesis infections lacks effective and specific indicators.Studies have found that D-dimer will increase in inflammatory diseases,so D-dimer may become a valuable biomarker for the diagnosis of chronic hip periprosthetic joint infection.OBJECTIVE:To observe the sensitivity and specificity of D-dimer in the detection of chronic hip joint prosthesis infection,so as to improve the accuracy of diagnosis of chronic hip joint prosthesis infection.METHODS:Hip revision cases from the First Affiliated Hospital of Guangzhou University of Chinese Medicine from 2010 to 2018 were retrospectively analyzed.According to diagnostic criteria,cases were divided into aseptic loosening group(n=83)and chronic periprosthesis infection group(n=61).D-dimer,procalcitonin,C-reactive protein,erythrocyte sedimentation rate and total leukocyte count were determined 3 days before surgery.The difference was compared between the two groups.The accuracy of diagnosis was analyzed by receiver operating characteristic curve and area under the curve.RESULTS AND CONCLUSION:(1)The D-dimer,procalcitonin,C-reactive protein,erythrocyte sedimentation rate,and total leukocyte count of the chronic periprosthesis infection group were significantly higher than those in the aseptic loosening group(P<0.001).(2)The area under the D-dimer curve was 0.898,which was more accurate than procalcitonin(0.816),erythrocyte sedimentation rate(0.773),C-reactive protein(0.708),and total leukocyte count(0.669),and the difference was statistically significant(P<0.001).(3)The optimal cut-off value for D-dimer was 1470.5μg/L.The sensitivity for diagnosis of joint infection around chronic hip prosthesis was 83.6%,and the specificity was 89.2%.(4)These results indicate that D-dimer is superior to other inflammatory indicators(procalcitonin,C-reactive protein,erythrocyte sedimentation rate and total leukocyte count)in the diagnosis of chronic hip prosthesis infection.The combination of D-dimer and other inflammatory indicators is conducive to early diagnosis of chronic hip prosthetic infections and to assess the condition.