血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析

Diagnostic value of ESR to C-Reactive protein ratio in diagnosis of periprosthetic joint Infection

目的:评估血沉与C-反应蛋白比值在诊断假体周围感染患者中的诊断价值。方法:本研究回顾性分析了从2015年1月至2020年12月住院的81例患者,PJI的诊断根据骨与肌肉感染协会2014年感染诊断标准。随访并比较了联合应用血沉与C-反应蛋白比值与经典诊断指标血沉与C-反应蛋白之间的诊断效能。结果:本研究共收集46例为无菌性松动患者组和35例关节假体周围感染组;男性32例,女性49例;感染组患者与非感染组患者平均年龄分别为(64.7±12.2)岁和(61.8±12.9)岁。感染组血沉、C-反应蛋白、血沉/C-反应蛋白比值以及白细胞计数均高于非感染组(P<0.001)。血沉与C-反应蛋白比值具有89.1%的灵敏度和82.7%的特异度,其AUC为0.882明显高于血沉(AUC,0.831),其诊断效能与C-反应蛋白(AUC,0.889)相当。血沉与C-反应蛋白比值相比经典诊断指标血沉与C-反应蛋白有较高的特异度和阳性预测值。结论:C-反应蛋白和血沉做为经典诊断指标,其比值能够有效提高诊断的特异性和阳性预测值,其有助于准确区分假体周围感染和无菌松动。

Objective Periprosthetic joint infection is a catastrophic complication after joint replacement,and with the rise in the number of joint replacement patients in China,the number of patients with periprosthetic joint infection has also increased,thus making a more accurate diagnosis of periprosthetic joint infection a hot topic of research for orthopedic surgeons.The purpose of this study was to assess the diagnostic value of ESR to C-reactive protein ratio in the diagnosis of patients with periprosthetic joint infections.Methods We retrospectively analyzed 81 patients hospitalized from January 2015 to December 2020,with periprosthetic joint infections diagnosed according to the Bone and Muscle Infection Society Infection Diagnosis 2014 Revised criteria.In this study we compared the diagnostic efficacy between the combined application of the ESR to C-reactive protein ratio and the classical diagnostic index ESR to C-reactive protein.Results In this study 46 cases were in the aseptic loosening patient group and 35 cases in the periprosthetic joint infection group;32 men and 49 women;the mean age of patients in the infected and non-infected groups was 64.7±12.2 and 61.8±12.9 years old,respectively.The ESR,C-reactive protein,ESR/C-reactive protein ratio and white blood cell count were higher in the infected group than in the non-infected group.The ESR to C-reactive protein ratio had a sensitivity of 89.1%and specificity of 82.7%,with an AUC of 0.882 significantly higher than that of ESR(AUC,0.831)and comparable to that of C-reactive protein(AUC,0.889).The ESR to C-reactive protein ratio had a higher specificity and positive predictive value compared to other indices.Conclusion The ESR to C-reactive protein ratio is a new index for the diagnosis of periprosthetic joint infection and helps to accurately differentiate periprosthetic joint infection from aseptic loosening.