关节假体周围感染患者血清学指标未达诊断阈值的影响因素分析

目的探讨关节假体周围感染(periprosthetic joint infection,PJI)患者血清C反应蛋白(C-reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation rate,ESR)不符合2011版美国肌肉骨骼感染协会(Musculoskeletal Infection Society,MSIS)诊断标准的影响因素。方法2011年12月至2019年12月因PJI住院治疗的患者328例,男152例、女176例,年龄(62.10±13.74)岁(范围24~87岁);膝关节172例(52.4%),髋关节151例(46.0%),肘关节4例(1.2%),肩关节1例(0.3%)。所有患者均于术前或应用抗生素前行CRP和ESR检测,PJI的诊断采用2011版MSIS诊断标准:CRP≥10 mg/L且ESR≥30 mm/1 h。将患者根据Tsukayama分型、病原体类型及免疫状态等进行分组,比较不同组别患者CRP和ESR不符合MSIS标准(即未达诊断阈值)的发生率。结果119例(36.3%,119/328)CRP或ESR实测值不符合MSIS诊断标准。Tsukayama分型组间不符合率的差异无统计学意义(χ^2=7.224,P=0.065);培养结果阴性组不符合率为46.4%,高于培养阳性组的27.4%(χ^2=12.276,P<0.001);免疫A级组不符合率为42.9%,高于免疫B级组的30.6%和C级组的23.8%(χ^2=6.586,P=0.037)。Logistic回归分析结果提示,培养结果阳性患者发生不符合标准的风险是培养阴性患者的0.420倍(P=0.001);免疫B级患者出现不符合标准现象的风险是免疫A级患者的0.578倍(P=0.040)。结论免疫状态好及培养结果阴性的PJI患者更容易出现血清学指标未达诊断阈值的现象,诊断时应特别注意综合其他指标,以防漏诊。

Relevant factors of serum tests did not meet the diagnostic threshold in patients with periprosthetic joint infection

Objective To investigate the relevant factors on serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)which did not meet the 2011 Musculoskeletal Infection Society(MSIS)diagnostic criteria in patients with periprosthetic joint infection(PJI).Methods During December 2011 to December 2019,a total of 328 patients with PJI were hospitalized for surgery or antibiotic administration,including 152 males and 166 females,aged 62.10±13.74(range 24-87)years.All patients underwent CRP and ESR before the antibiotic administration or the revision surgery.PJI was diagnosed based on the 2011 MSIS diagnostic criteria.There were 172 knee PJIs(52.4%),151 hip PJIs(46.0%),4 elbow PJIs(1.2%)and 1 shoulder PJI(0.3%).Patients were classified according to Tsukayama type,pathogen and immune status.We,further,analyzed relevant factors on CRP and ESR levels in PJI patients.Results There were 119 patients with CRP and ESR did not meet the MSIS diagnostic criteria,accounting for 36.3%(119/328).Furthermore,there was no significant difference in Tsukayama types among them(χ^2=7.224,P=0.065).In addition,the ratio was 46.4%in patients with negative culture results,which was higher than that in positive culture results(27.4%,χ^2=12.276,P<0.001).The ratio was 42.9%in patients with normal immune status(grade A),which was higher than that of immune grade B(30.6%)and of immune grade C(23.8%)(χ^2=6.586,P=0.037).Multivariate logistic regression analysis showed the negative association between positive culture results and immune grade B with nonconformity(OR=0.420,P=0.001;OR=0.578,P=0.04).Conclusion The serum tests level unmet the threshold in MSIS criteria usually present in PJI patients with normal immune status and negative culture results.Thus,we should utilize other methods for diagnosing PJI.