炎症性关节炎患者的周围假肢关节感染:最优的测试,以区分从爆发
Susan M Goodman1, Insa Mannstadt1, Kathleen Tam2
1From the Department of Rheumatology, Hospital for Special Surgery, New York, NY.
概括
在炎症性关节炎 (IA) 患者中诊断周围假肢关节感染 (PJI) 很困难. 虽然突多态核中性粒细胞百分比 (%PMN),C反应蛋白 (CRP) 和α-defensin对PJI表现出敏感性,但它们在IA爆发中的特异性是有限的.
科学领域:
- 整形外科 整形外科 整形外科
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
背景情况:
- 在炎症性关节炎 (IA) 患者中诊断周围假肢关节感染 (PJI) 是一个挑战,因为IA爆发和感染之间的症状重叠.
- 骨关节炎中PJI的现有诊断标准可能无法直接适用于IA患者.
研究的目的:
- 评估在患有炎症性关节炎症爆发的患者中已建立的周围假肢关节感染诊断标志物的实用性.
- 为了确定在患有IA爆发的患者中,在骨关节炎中诊断PJI的最佳测试是否有效.
主要方法:
- 一项横截面研究从2020年10月到2022年7月招募了52名患者,分为三个组:PJI修订,IA爆发和IA无菌修订.
- 用克鲁斯卡尔-瓦利斯和费舍尔精确测试来评估灵敏度和特异性,在队列之间比较了血液和突液标记物.
- 分析的关键标志物包括C反应蛋白 (CRP),突液多态核中性粒细胞百分比 (%PMN) 和α-defensin.
主要成果:
- 周围假肢关节感染病例显示CRP和突液%PMN的升高.
- 在93%的PJI病例中,α-defensin检测阳性,明显高于IA爆发 (20%) 或IA无菌 (6%) 组 (p < 0.01).
- 同胞白细胞计数>3000/μL和阳性α-defensin显示出100%的感染敏感性,但具有较低的特异性 (分别为50%和79%).
结论:
- 突%PMN,CRP和α-defensin是诊断PJI的敏感指标.
- 然而,这些标记物缺乏足够的特异性,在炎症性关节炎发作期间可以产生积极的结果,使诊断复杂化.
- 在炎症性关节炎的背景下,需要进一步完善PJI的诊断策略.
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