在周围假肢关节感染中重新检查D-二聚体:一个全面的系统综述和对子组和异质性探索的元分析
Lei Luo1, Chao Huang, Zeyu Luo
1Department of Orthopaedics and Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
International journal of surgery (London, England)
|January 20, 2026
概括
D-二聚体对诊断周围假肢关节感染 (PJI) 具有中等准确性. 它作为初步分拣工具很有用,特别是在低流行率的环境中,并且可以在与C反应蛋白结合时帮助排除PJI.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 诊断的准确性 诊断的准确性
- 生物标志物 生物标志物
背景情况:
- D-二聚体是诊断周围假肢关节感染 (PJI) 的一个有趣的生物标志物.
- 之前关于其对PJI的诊断准确性的证据是不确定的.
- 这项研究系统地审查和分析了PJI的D-二聚合物的诊断性能.
研究的目的:
- 为了评估D-二次体在诊断PJI的诊断性能.
- 探索诊断准确性研究中异质性的来源.
- 评估证据的确定性,以证明D-二次元的诊断效用.
主要方法:
- 在主要数据库 (PubMed,Scopus,Web of Science,Embase,Cochrane) 进行系统的文献搜索,截至2025年5月10日.
- 包括30项涉及6444名患者的研究,这些研究评估了PJI诊断的D-二聚物.
- 质量评估 (QUADAS-2),元回归,灵敏度分析,以及用于证据确定性的GRADE方法.
主要成果:
- 对于PJI诊断的D-二元体的聚合灵敏度为0.74 (95% CI 0.69-0.79) 和特异性为0.72 (95% CI 0.66-0.77).
- 从总结ROC分析中,曲线下的面积 (AUC) 为0.79 (95%CI为0.76-0.83).
- 标本类型,感染类型,手术地点和研究设计被确定为异质性的来源.
结论:
- D-二次体显示PJI诊断的低到中等确定性证据,最好用作初始分拣或排除测试.
- 在血清检测,慢性感染和膝盖PJI中观察到更高的诊断性能.
- 在连续测试中将D-二聚合物与C-反应蛋白结合起来,得到了高确定性证据的支持,以确认PJI.
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