引用本文:张永超,黄金承,张新安,刘云涛,连鸿凯.感染和凝血相关指标在诊断慢性关节假体周围感染中的价值[J].中国临床新医学,2021,14(6):606-610.
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感染和凝血相关指标在诊断慢性关节假体周围感染中的价值
张永超,黄金承,张新安,刘云涛,连鸿凯
450000 河南,郑州大学第二附属医院骨科(张永超);450000 郑州,河南省人民医院骨科(黄金承);450000 河南,郑州市中心医院骨科(张新安,刘云涛,连鸿凯)
摘要:
[摘要] 目的 探讨血液学感染和凝血指标C反应蛋白(CRP)、红细胞沉降率(ESR)、纤维蛋白原(FBG)、D-二聚体(D-dimer)和血小板(PLT)在诊断慢性关节假体周围感染(PJI)中的价值。方法 收集2018年10月至2021年1月郑州大学附属郑州中心医院收治并完成初次关节置换术的149例患者资料。根据术后出现慢性PJI情况分为慢性PJI组(47例)和无感染对照组(102例)。比较两组术后CRP、ESR、FBG、D-dimer、PLT和PLT/平均血小板体积(MPV)的复查结果,采用ROC法分析CRP、ESR、FBG、D-dimer、PLT和PLT/MPV对慢性PJI的诊断效力。结果 在关节置换术后,慢性PJI组CRP、ESR、FBG、D-dimer、PLT和PLT/MPV的水平显著高于无感染对照组(P<0.05)。ROC分析结果显示,CRP、ESR、D-dimer,FBG、PLT/MPV均具有诊断慢性PJI的价值(P<0.05)。进一步分析显示,CRP、ESR、FBG和D-dimer在诊断慢性PJI方面比较差异无统计学意义(P>0.05);CRP、ESR、FBG和D-dimer的诊断效能显著高于PLT和PLT/MPV(P<0.05)。但是,CRP、ESR、FBG和PLT/MPV诊断慢性PJI的截断值均在正常值范围内,而只有D-dimer的截断值高于正常值范围。结论 FBG、D-dimer、CRP和ESR诊断慢性PJI的效能相当,且以D-dimer指标更具临床指导意义。
关键词:  关节假体周围感染  纤维蛋白原  D-二聚体  血小板  诊断
DOI:10.3969/j.issn.1674-3806.2021.06.17
分类号:R 684
基金项目:河南省科技攻关项目(编号:202102310113)
The value of infection and blood coagulation related indicators in diagnosis of chronic prosthetic joint infection
ZHANG Yong-chao, HUANG Jin-cheng, ZHANG Xin-an, et al.
Department of Orthopedics, the Second Affiliated Hospital of Zhengzhou University, Henan 450000, China
Abstract:
[Abstract] Objective To explore the value of hematological infection and blood coagulation indicators including C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), fibrinogen(FBG), D-dimer and platelet(PLT) in diagnosis of chronic prosthetic joint infection(PJI). Methods The data of 149 patients who were admitted to the Zhengzhou Central Hospital Affiliated to Zhengzhou University and completed the first joint replacement surgery from October 2018 to January 2021 were collected. The patients were divided into the chronic PJI group(47 cases) and the non-infected control group(102 cases) according to the situations of postoperative chronic PJI. The reexamination results of postoperative CRP, ESR, FBG, D-dimer, PLT and PLT/mean platelet volume(MPV) were compared between the two groups. Receiver operating characteristic curve(ROC) method was used to analyze the diagnostic efficacy of CRP, ESR, FBG, D-dimer, PLT and PLT/MPV for chronic PJI. Results After joint replacement, the levels of CRP, ESR, FBG, D-dimer, PLT and PLT/MPV in the chronic PJI group were significantly higher than those in the non-infected control group(P<0.05). The results of ROC analysis showed that CRP, ESR, D-dimer, FBG, PLT/MPV were all valuable in the diagnosis of chronic PJI(P<0.05). Further analysis showed that CRP, ESR, FBG and D-dimer were not statistically different in the diagnosis of chronic PJI(P>0.05), and the diagnostic efficiency of CRP, ESR, FBG and D-dimer was significantly higher than that of PLT and PLT/MPV(P<0.05). However, the cut-off values of CRP, ESR, FBG and PLT/MPV in the diagnosis of chronic PJI were all within the normal ranges, while only the cut-off value of D-dimer was above the normal range. Conclusion The efficacy of FBG, D-dimer, CRP and ESR in the diagnosis of chronic PJI is similar, and D-dimer index has more clinical guiding significance.
Key words:  Prosthetic joint infection(PJI)  Fibrinogen(FBG)  D-dimer  Platelet(PLT)  Diagnosis