这位成年患者是否患有败血性关节炎?
Mary E Margaretten1, Jeffrey Kohlwes, Dan Moore
1Division of Rheumatology, Prime Program, Department of Medicine, University of California, San Francisco, CA 94143-0633, USA. mary.margaretten@ucsf.edu
JAMA
|April 5, 2007
概括
及时诊断败血性关节炎对于减少并发症至关重要. 临床评估,特别是流体白细胞 (WBC) 计数和多态核细胞百分比,有助于在培养结果之前评估败血性关节炎的可能性.
科学领域:
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
- 诊断的准确性 诊断的准确性
背景情况:
- 败血性关节炎需要及时识别和治疗,以尽量减少患者的发病率和死亡率.
- 临床评估在初步评估急性关节疼痛和胀的患者中起着关键作用.
研究的目的:
- 系统地审查诊断准确性和临床评估的准确性对非冠状菌性细菌性关节炎.
- 确定关键的历史,体检和实验室发现,表明有败血性关节炎.
主要方法:
- 在PubMed和EMBASE数据库 (1966-2007) 中进行了全面的文献搜索.
- 包括使用原始数据对诊断败血性关节炎的历史,物理,血清或突液数据准确性的研究.
- 使用了三个作者独立的数据抽象.
主要成果:
- 分析了14项涉及6242名患者的研究;653人确诊患有败血性关节炎.
- 危险因素包括年龄,糖尿病,类风湿性关节炎,关节手术,假肢,皮肤感染和艾滋病毒.
- 主要临床发现:关节疼痛 (85%的敏感度),关节 (78%的敏感度) 和发烧 (57%的敏感度).
- 同胞液白细胞 (WBC) 计数和多态核细胞百分比是强大的诊断指标.
- 较高的突液WBC计数显著增加了感染性关节炎的可能性 (LR高达28.0对于>100,000/microL).
- 突液中多态核细胞数≥90%强烈表明有败血性关节炎 (LR 3.4).
结论:
- 临床发现可以识别患有外围,单关节性关节炎的患者,他们可能患有败血性关节炎.
- 在格拉姆染色和培养结果之前,评估败血性关节炎的可能性的关节液白细胞计数和多态核细胞百分比是必不可少的.
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