关节液AD-1、CRP及sTREM-1在全髋关节置换术后假体周围感染中的诊断价值

Diagnostic value of Synovial fluid AD⁃1,CRP and sICAM⁃1 in periprosthetic joint infection after total hip arthroplasty

目的探讨关节液α防御素⁃1(AD⁃1)、C⁃反应蛋白(CRP)、可溶性细胞间黏附分子⁃1(sICAM⁃1)对全髋关节置换术(THA)患者术后假体周围感染(PJI)的诊断价值。方法选取2016年8月至2022年5月期间于富顺县中医医院就诊的THA患者122例,根据THA患者感染情况分为PJI组(37例)和非PJI组(85例)。对两组的关节液AD⁃1、CRP及sICAM⁃1表达水平进行检测,并绘制ROC曲线分析各指标对THA患者术后PJI的诊断效能。结果相比非PJI组THA患者,PJI组的关节液AD⁃1、CRP及sICAM⁃1的表达水平明显升高,差异有统计学意义(Z=11.435,8.265,7.834,P<0.05);ROC曲线分析表明,AD⁃1、CRP及sICAM⁃1的AUC值分别为0.827(95%CI:0.732~0.923)、0.825(95%CI:0.748~0.902)和0.764(95%CI:0.673~0.855),三者联合检测的AUC值为0.843(95%CI:0.785~0.901),明显高于AD⁃1、CRP及sICAM⁃1的单独检测(P<0.05)。联合检测诊断的灵敏度、特异度和准确度分别为86.49%、100.0%和95.90%,诊断准确度明显高于三者单独检测(P<0.05)。结论THA患者术后PJI的关节液AD⁃1、CRP及sICAM⁃1指标随之增高,而三者联合检测在THA患者术后PJI的诊断中具有最优的诊断价值。

Objective To evaluate the diagnostic value of synovial fluidα⁃defensin⁃1(AD⁃1),C⁃reactive protein(CRP)and soluble intercellular adhesion molecule⁃1(sICAM⁃1)in periprosthetic joint in⁃fection(PJI)after total hip arthroplasty(THA).Methods 122 patients with THA who were treated in our hospital from August 2016 to May 2022 were selected and divided into the PJI group(37 cases)and the non PJI group(85 cases)according to their infection.The expression levels of AD⁃1,CRP,and sICAM⁃1 in syno⁃vial fluid of patients with THA were detected between the two groups,and the ROC curve was drawn to ana⁃lyze the diagnostic efficacy of each indicator for postoperative PJI in patients with THA.Results Compared with THA patients in the non PJI group,the expression levels of AD⁃1,CRP and sICAM⁃1 in synovial fluid of the PJI group were significantly higher(Z=11.435,8.265,7.834,P<0.05).The ROC curve analysis showed that the AUC values of AD⁃1,CRP and sICAM⁃1 were 0.827(95%CI:0.732~0.923,0.825(95%CI:0.748~0.902)and 0.764(95%CI:0.673~0.855)respectively,while the AUC value of the combined detection of AD⁃1,CRP and sICAM⁃1 was 0.927(95%CI:0.867~0.987),which was significantly higher than that of AD⁃1,CRP and sICAM⁃1 alone(P<0.05).The sensitivity,specificity and accuracy of combined detection were 86.49%、100.0%and 95.90%respectively.The diagnostic accuracy of combined detection was significantly higher than that of the single detection(P<0.05).Conclusion The levels of synovial fluid AD⁃1,CRP,and sICAM⁃1 in postoperative PJI of THA patients are increased,and the combined detection of the three indicators has the best diagnostic value in the diagnosis of postoperative PJI of THA patients.