患有炎症性关节炎的患者周围假肢关节感染的诊断挑战和风险分层
Paweł Kasprzak1,2, Wiktoria Skała3, Mariusz Gniadek2
1Department of Orthopedics and Traumatology, Medical University of Warsaw, 4 W.H. Lindleya St, 02-005 Warsaw, Poland.
Journal of clinical medicine
|June 26, 2025
概括
在炎症性关节炎 (IA) 中诊断周围假肢关节感染 (PJI) 很困难. 像BPI和ELA-2这样的新生物标志物在IA患者中改善了PJI检测的前景.
科学领域:
- 整形外科手术 整形外科手术
- 类风湿病学 类风湿病学
- 传染性疾病 传染性疾病
背景情况:
- 精确检测周围假肢关节感染 (PJI) 在炎症性关节炎 (IA) 患者中具有挑战性,包括类风湿性关节炎 (RA).
- 重叠的炎症参数和免疫抑制疗法复杂化了IA中的PJI诊断.
研究的目的:
- 审查目前的诊断挑战和在IA患者中PJI的新兴生物标志物.
- 在这个复杂的患者群体中确定改善PJI诊断的策略.
主要方法:
- 从2010-2025年对PubMed/MEDLINE文献进行叙事审查.
- 搜索词包括"周围假肢关节感染"",炎症性关节炎"",类风湿性关节炎"",诊断"",生物标志物"",突液"和"免疫抑制".
- 在最终分析中包括了50项研究.
主要成果:
- 患有PJI的IA患者通常更年轻,女性,具有更高的并发症负担,并增加了假阳性组织学和培养负面感染.
- 标准生物标志物 (血清CRP,ESR,突液WBC和PMN%) 在IA中具有低至中等的诊断价值,其最佳值与MSIS不同.
- 阿尔法-防御素显示出优异的性能;新型标记物 (血清BPI,ELA-2,突CRP,calprotectin) 和PCR显示出增加的潜力.
结论:
- 疾病和治疗混因素显著阻碍了IA患者的PJI诊断.
- 需要IA特定的诊断方法和调整的生物标志物值.
- 新兴的生物标志物,特别是BPI,ELA-2和突CRP,需要进一步验证,以改善PJI检测和术后管理.
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