1.中山大学附属第一医院关节外科,广东 广州 510080
2.广东省人民医院骨科,广东 广州 510080
吴小宇,第一作者,博士生,研究方向:关节置换,假体周围感染,E-mail:wuxy278@mail2.sysu.edu.cn
叶勇裕,并列第一作者,博士,主治医师,研究方向:关节置换,假体周围感染,E-mail:yeyongyu@gdph.org.cn
纸质出版日期:2023-03-20,
收稿日期:2022-05-15,
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吴小宇,叶勇裕,潘柏祺等.凝血相关指标在关节假体周围感染中的诊断价值[J].中山大学学报(医学科学版),2023,44(02):188-197.
WU Xiao-yu,YE Yong-yu,PAN Bai-qi,et al.Coagulation Factors for Diagnosis of Periprosthetic Joint Infection[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):188-197.
吴小宇,叶勇裕,潘柏祺等.凝血相关指标在关节假体周围感染中的诊断价值[J].中山大学学报(医学科学版),2023,44(02):188-197. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0202.
WU Xiao-yu,YE Yong-yu,PAN Bai-qi,et al.Coagulation Factors for Diagnosis of Periprosthetic Joint Infection[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):188-197. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0202.
目的
2
关节假体周围感染(PJI)是目前关节置换术后最严重的并发症。尽管许多标志物在PJI的诊断中取得了良好的效果,但早期的诊断仍然缺乏金标准。本研究旨在探讨凝血相关指标与全关节置换术(TJA)患者术后发生PJI的关系。
方法
2
我们进行了一项回顾性队列研究,选取在2011年1月至2022年1月期间接受了髋关节或膝关节置换术的总共2 517例患者(2 394例初次置换,87例无菌翻修,36例PJI)。我们应用多因素logistic回归分析,对比PJI组、初次置换和无菌翻修组之间凝血相关指标的差异。应用观察者操作特性曲线(ROC)和曲线下面积(AUC)来评估凝血相关指标在PJI中的诊断价值。
结果
2
本研究纳入的指标包括血浆纤维蛋白原(FBG),凝血酶原时间(PT),凝血酶时间(TT),活化部分凝血活酶时间(APTT),血小板(PLT),平均血小板体积(MPV),血小板分布宽度(PDW),血小板比容(PCT),PLT/MPV,PLT/PDW和PLT/PCT。与其他凝血相关指标相比,FGB水平升高与PJI发生风险密切相关。PJI组与初次置换组相比,FBG的最佳诊断界值为4.53 g/L,诊断敏感性为47.22%,特异性为93.07%;与翻修组比,FBG的最佳诊断界值为4.44 g/L,诊断敏感性为47.22%,特异性为95.40%。ROC曲线分析提示FBG具有中度诊断效能,表明其为PJI诊断的潜在标志物。
结论
2
FBG水平与PJI发生风险显著相关,可在临床中作为诊断PJI的重要指标。
Objective
2
Periprosthetic joint infections (PJI) are currently the most calamitous complication after arthroplasty. Although achievements have been made in many markers for the diagnosis of PJI, the lack of a gold standard remains a great obstacle for early diagnosis. This study aimed to investigate the association between coagulation markers and the development of PJI in patients undergoing revision total joint arthroplasty (TJA).
Methods
2
We conducted a retrospective cohort study with a total of 2 517 patients who underwent hip or knee arthroplasties from January 2011 to January 2022 (2 394 with primary TJA, 87 with aseptic revision and 36 with PJI). We applied univariate analysis and multivariate logistic regression to analyze differences of coagulation factors between primary TJA and aseptic revision or PJI group. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to measure the diagnostic value of coagulation factors in predicting PJI.
Results
2
Coagulation factors and their ratios including plasma fibrinogen (FBG), prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), platelet (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), PLT / MPV, PLT / PDW and PLT / PCT were included in this study. High FGB level was strongly correlated with the risk of PJI compared to other coagulation factors. The optimal threshold value of FBG was 4.53 g/L with a sensitivity of 47.22%, a specificity of 93.07% (Primary TJA group vs. PJI group). Similarly, the optimal threshold value of FBG was 4.44 g/L with a sensitivity of 47.22%, a specificity of 95.40% between the other two groups (Aseptic revision group vs. PJI group). ROC curve analysis demonstrated moderate diagnostic performance of FBG (AUC value), indicating a potential to be a diagnostic marker for PJI.
Conclusions
2
FBG is significantly correlated with PJI and it can be used as a potential non-invasive marker for early detection. It may serve as a safe and cost-effective tool for assessing PJI in clinical work.
关节假体周围感染血浆纤维蛋白原凝血相关指标诊断
periprosthetic joint infectionplasma fibrinogencoagulation-related indicatorsdiagnosis
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