| 新型血液标志物白球比和纤维蛋白原等对关节假体周围感染术前的诊断价值 |
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Received:January 22, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 朱耿耀 |
ZHU Geng-yao |
徐州市中心医院骨科, 江苏 徐州 221009 |
Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China |
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| 马超 |
MA Chao |
徐州市中心医院骨科, 江苏 徐州 221009 |
Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China |
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| 刘光旺 |
LIU Guang-wang |
徐州市中心医院骨科, 江苏 徐州 221009 |
Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China |
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| 满家政 |
MAN Jia-zheng |
徐州市中心医院骨科, 江苏 徐州 221009 |
Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China |
manjiazheng@163.com |
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| 期刊信息：《中国骨伤》2025年38卷，第1期，第55-60页 |
| DOI：10.12200/j.issn.1003-0034.20230265 |
| 基金项目:江苏省卫生健康委科研项目(编号:M2022048);徐州市引进临床医学专家团队项目(编号:2019TD002) |
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目的: 探讨关节假体周围感染(periprosthetic joint infection，PJI)的新型血液学标志物在术前诊断PJI的应用价值。
方法: 单中心回顾性分析2016年1月至2022年6月收治的全关节置换术后需全髋或全膝关节翻修的患者149例，男63例，女86例;年龄47~93(69.5±11.8)岁。诊断为PJI的患者46例(PJI组)，男22例，女24例;年龄(71.3±12.5)岁;身体质量指数(body mass index，BMI)为(26.4±3.1)kg·m-2。诊断为无菌性假体松动的患者103例(无菌性组)，男41例，女62例;年龄(68.7±11.4)岁;BMI为(25.8±3.5)kg·m-2。入院时测定C-反应蛋白、红细胞沉降率(erythrocyte sedimentation rate，ESR)、白蛋白、球蛋白、白球比、D-二聚体和纤维蛋白原。通过受试者工作特征(receiver operating characteristic，ROC)曲线、敏感度和特异性分析比较各血液标志物对术前诊断PJI的价值。
结果: PJI组的C-反应蛋白16.6(7.6，4.5) mg·L-1、ESR为17.0(12.8，35.5) mm·h-1、D-二聚体1.0(0.5，3.1) μg·L-1、纤维蛋白原4.2(3.2，5.5) g·L-1、球蛋白35.4(31.0，38.9) g·L-1均高于无菌性组4.2(2.6，7.8) mg·L-1，12.0(8.0，20.0) mm·h-1，0.4(0.2，0.7) μg·L-1，2.8(2.4，3.3) g·L-1，28.6(24.5，31.9) g·L-1(P<0.05);相反，PJI组的白蛋白35.3(32.3，37.5) g·L-1和白球比1.0(0.9，1.1)均明显低于无菌性组39.8(36.1，41.8) g·L-1，1.4(1.3，1.5)，P<0.05。相比于其他血液学标志物，只有白球比和纤维蛋白原的曲线下面积(area under the curve，AUC)>0.8。其中纤维蛋白原的最佳截断值为3.4 g·L-1，AUC为0.820，敏感度为69.57%，特异性为84.47%。白球比的最佳截断值为1.18，AUC为0.813，敏感度为82.61%，特异性为78.64%。
结论: 白球比和纤维蛋白原是术前诊断PJI可靠的血液学标志物。 |
| [关键词]:白球比 纤维蛋白原 术前诊断 关节假体周围感染 |
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| Preoperative diagnostic efficacy of novel blood markers white blood cell ratio and fibrinogen levels in periprosthetic joint infection |
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Abstract:
Objective To investigate the clinical utility of novel of new hematological markers in the preoperative diagnosis of periprosthetic joint infection (PJI).
Methods A retrospective analysis was conducted on a total of 149 patients who underwent revision of total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single center between January 2016 and June 2022,including 63 males and 86 females,aged from 47 to 93 years old with an average of (69.5±11.8) years old. Of them,46 were diagnosed as PJI(PJI group),including 22 males and 24 females. The mean age was (71.3±12.5) years old. The body mass index (BMI) was (26.4±3.1) kg·m-2. And 103 patients were diagnosed as aseptic prosthesis loosening (aseptic group),including 41 males and 62 females. The mean age was (68.7±11.4) years old. The BMI was (25.8±3.5) kg·m-2. Preoperatively analyzed clinical parameters included C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),albumin,globulin,albumin-to-globulin ratio (AGR),plasma D-dimer,and plasma fibrinogen. The receiver operating characteristic curve (ROC),sensitivity,and specificity analysis were employed to compare the diagnostic value of each blood marker in preoperative PJI diagnosis.
Results In the PJI group,the levels of CRP were 16.6 (7.6,4.5) mg·L-1,ESR was 17.0 (12.8, 35.5) mm·h-1,plasma D-dimer was 1.0 (0.5,3.1) μg·L-1,and plasma fibrinogen was 4.2 (3.2,3.1) mg·L-1;all of which were higher compared to the aseptic group with CRP at 4.2 (2.6,7.8) mg·L-1,ESR at 12.0(8.0,20.0)mm·h-l,D-dimer at 0.4(0.2,0.7)μg·L-1,and fibrinogen at 2.8(2.4,3.3) g·L-1(P<0.05). However,the albumin level of 35.3 (32.3,37.5) g·L-1 and the WBC ratio of 1.0(0.9,1.1) in the PJI group were significantly lower compared to the aseptic group with levels of 39.8 (36.1,41.8) g·L-1 and 1.4 (1.3,1.5),respectively (P<0.05). Only the area under the curve (AUC) of AGR and plasma fibrinogen were greater than 0.8. The optimal predictive cut-1off,AUC,sensitivity and specificity were 3.4 g·L-1,0.820,69.57% and 84.47% for plasma fibrinogen; 1.18,0.813,82.61% and 78.64% for AGR,respectively.
Conclusion AGR and plasma fibrinogen are promising blood markers for improving the diagnosis of PJI. |
| KEYWORDS:Albumin-to-globulin ratio Fibrinogen Preoperative diagnosis Periprosthetic joint infection |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 朱耿耀,马超,刘光旺,满家政.新型血液标志物白球比和纤维蛋白原等对关节假体周围感染术前的诊断价值[J].中国骨伤,2025,38(1):55~60 |
| 英文格式: | ZHU Geng-yao,MA Chao,LIU Guang-wang,MAN Jia-zheng.Preoperative diagnostic efficacy of novel blood markers white blood cell ratio and fibrinogen levels in periprosthetic joint infection[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(1):55~60 |
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