CAJ | 학술논문

背景：假体周围感染是关节置换后一种难以处理的并发症，早期诊断是治疗的关键，寻找到一种反应快速的、高敏感度和特异度的分子生物学标志物可显著优化假体周围感染的诊断过程。目的：监测血降钙素原、白细胞介素6和脂多糖结合蛋白水平，并与血白细胞计数和C-反应蛋白水平比较，明确上述指标鉴别关节置换后感染的敏感度和特异度。方法：招募2008年1月至2013年12月因关节置换后疼痛就诊于济宁医学院附属医院的患者81例。所有的感染患者修复手术分为两期，一期彻底清创，安装临时占位器，平均3个月后进行二期重建。术前1 d采集静脉血，检测降钙素原、白细胞介素6、脂多糖结合蛋白、白细胞计数和C-反应蛋白水平，术中采集滑膜及假体周围假包膜的样本，行细菌及组织形态学检查。应用受试者工作特征曲线计算敏感度和特异度。结果与结论：单因素方差分析结果显示，脂多糖结合蛋白的受试者工作特征曲线最大，为0.962，95%置信区间0.924-1.000，诊断价值最佳，此时的临界值为23.5μg/L，表明术前患者血脂多糖结合蛋白超过23.5μg/L时，诊断为假体周围感染的可能最大；其次是C-反应蛋白，其受试者工作特征曲线为0.871；而白细胞的受试者工作特征曲线接近0.5，术前根据白细胞计数诊断假体周围感染的价值不大。提示检测脂多糖结合蛋白对于关节置换后假体周围感染的诊断具有良好的应用前景，它对假体周围感染的阳性预测率和阴性预测率均很高。
배경：가체주위감염시관절치환후일충난이처리적병발증，조기진단시치료적관건，심조도일충반응쾌속적、고민감도화특이도적분자생물학표지물가현저우화가체주위감염적진단과정。목적：감측혈강개소원、백세포개소6화지다당결합단백수평，병여혈백세포계수화C-반응단백수평비교，명학상술지표감별관절치환후감염적민감도화특이도。방법：초모2008년1월지2013년12월인관절치환후동통취진우제저의학원부속의원적환자81례。소유적감염환자수복수술분위량기，일기철저청창，안장림시점위기，평균3개월후진행이기중건。술전1 d채집정맥혈，검측강개소원、백세포개소6、지다당결합단백、백세포계수화C-반응단백수평，술중채집활막급가체주위가포막적양본，행세균급조직형태학검사。응용수시자공작특정곡선계산민감도화특이도。결과여결론：단인소방차분석결과현시，지다당결합단백적수시자공작특정곡선최대，위0.962，95%치신구간0.924-1.000，진단개치최가，차시적림계치위23.5μg/L，표명술전환자혈지다당결합단백초과23.5μg/L시，진단위가체주위감염적가능최대；기차시C-반응단백，기수시자공작특정곡선위0.871；이백세포적수시자공작특정곡선접근0.5，술전근거백세포계수진단가체주위감염적개치불대。제시검측지다당결합단백대우관절치환후가체주위감염적진단구유량호적응용전경，타대가체주위감염적양성예측솔화음성예측솔균흔고。
BACKGROUND:Periprosthetic joint infection is a complication that is difficult to deal with after joint arthroplasty. Early diagnosis is the key to treatment. To find a fast response, high-sensitivity and high-specificity molecular biomarker can significantly optimize the diagnosis process of periprosthetic joint infection. OBJECTIVE:To monitor blood procalcitonin, interleukin-6 and lipopolysaccharide binding protein levels, to compare with blood leukocyte count and C-reactive protein levels, to identify above indexes, and to distinguish sensitivity and specificity of periprosthetic joint infection. METHODS: A total of 81 patients with pain after arthroplasty who were treated in Affiliated Hospital of Jining Medical Colege from January 2008 to December 2013 were enroled in this study. The repair surgery of al patients was divided into two stages. In the first stage, complete debridement and the instalation of temporary occupancy device were conducted. After 3 months averagely, two-phase reconstruction was performed. At 1 day before surgery, venous blood was colected. Calcitonin, interleukin 6, lipopolysaccharide binding protein, leukocyte count and C- reactive protein levels were detected. During the operation, synovial membrane and sample of false envelope around the prosthesis were colected. Bacterial and histological examinations were performed. The sensitivity and specificity were calculated using receiver operating characteristic curve. <br> RESULTS AND CONCLUSION: One-way analysis of variance results showed that the receiver operating characteristic curve of lipopolysaccharide binding protein was bigger, 0.962; 95 confidence interval 0.924-1.000. Diagnostic value was optimal, and the critical value was 23.5 μg/L. These data suggested that when lipopolysaccharide binding protein exceeded 23.5 μg/L before surgery, periprosthetic joint infection would be identified. The receiver operating characteristic curve of C-reactive protein was 0.871. The receiver operating characteristic curve of leukocytes was close to 0.5. The diagnostic value of leukocyte count on periprosthetic joint infection was not great. These findings indicate that lipopolysaccharide binding protein has good application prospect in the diagnosis of periprosthetic joint infection after joint replacement, and shows high positive predictive rate and negative predictive rate of periprosthetic joint infection.