血清D-二聚体在关节假体周围感染诊断中的意义Significance of serum D-dimer in the diagnosis of prosthetic joint infection
黄金承;王振;赵永强;强硕;金毅;郑稼;
摘要(Abstract):
[目的]探讨血清D-二聚体在关节假体周围感染(prosthetic joint infection, PJI)诊断中的意义。[方法]回顾性分析本科2016年6月~2018年6月收治的80例患者,其中初次置换组33例,PJI分期翻修24例,无菌松动翻修术组23例。比较三组患者术前血清C-反应蛋白(CRP)、血沉(ESR)、D-二聚体等数据。[结果]三组患者一般资料比较差异无统计学意义(P>0.05)。PJI患者血清CRP、ESR水平显著高于初次关节置换及无菌性松动患者(P<0.05),PJI患者血清D-二聚体水平显著高于初次置换者(P<0.05),但与无菌性松动患者体内D-二聚体水平差异不具有统计学意义(P>0.05)。当以D-二聚体>0.85μg/L为PJI诊断标准时,血清CRP、ESR、D-二聚体诊断PJI的敏感性、特异性类似,差异无统计学意义(P>0.05)。当以D-二聚体>0.5μg/L为PJI诊断标准时,D-二聚体诊断PJI的敏感性与CRP及ESR类似(P>0.05),但特异性差于CRP及ESR,差异具有统计学意义(P<0.05)。[结论]与CRP、ESR相比,血清D-二聚体在PJI诊断中无明显优势。
关键词(KeyWords): 关节假体周围感染;C反应蛋白;血沉;D-二聚体;诊断
基金项目(Foundation):
作者(Author): 黄金承;王振;赵永强;强硕;金毅;郑稼;
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参考文献(References):
- [1] Kim TW, Kim DH, Oh WS, et al. Analysis of the causes of elevated c-reactive protein level in the early postoperative period after primary total knee arthroplasty[J]. J Arthroplasty, 2016, 31(9):1990-1996.
- [2] McArthur BA, Abdel MP, Taunton MJ, et al. Seronegative infections in hip and knee arthroplasty:periprosthetic infections with normal erythrocyte sedimentation rate and C-reactive protein level[J]. Bone Joint J, 2015, 97-B(7):939-944.
- [3] O'Bryan TA, Agan BK, Tracy RP, et al. Brief report:racial comparison of d-dimer levels in us male military personnel before and after hiv infection and viral suppression[J]. J Acquir Immune Defic Syndr, 2018, 77(5):502-506.
- [4] Lee JW, Her SM, Kim JH, et al. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection[J]. Pediatr Nephrol, 2018, 33(4):631-637.
- [5] Lee YS, Lee YK, Han SB, et al. Natural progress of D-dimer following total joint arthroplasty:a baseline for the diagnosis of the early postoperative infection[J]. J Orthop Surg Res, 2018, 13(1):
- [6] 3S6h.ahi A, Kheir MM, Tarabichi M, et al. Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation[J]. J Bone Joint Surg Am 2017, 99(17):1419-1427.
- [7] Glehr M, Friesenbichler J, Hofmann G, et al. Novel biomarkers to detect infection in revision hip and knee arthroplasties[J]. Clin Orthop Relat Res, 2013, 471(8):2621-2628.
- [8] Mumingjiang Y, Zhou X, He R. Value of knee skin temperature measured by infrared thermography and soluble intercellular adhesion molecule-1 in the diagnosis of peri-prosthetic knee infection in Chinese individuals following total knee arthroplasty[J]. Chin Med J(Engl), 2014, 127(17):3105-3109.
- [9] Galliera E, Drago L, Vassena C, et al. Toll-like receptor 2 in serum:a potential diagnostic marker of prosthetic joint infection[J].J Clin Microbiol, 2014, 52(2):620-623.
- [10] Dapunt U, Giese T, Maurer S, et al. Neutrophil-derived MRP-14is up-regulated in infectious osteomyelitis and stimulates osteoclast generation[J]. J Leukoc Biol, 2015, 98(4):575-582.
- [11] Busso N, Hamilton JA. Extravascular coagulation and the plasminogen activator/plasmin system in rheumatoid arthritis[J]. Arthritis Rheum, 2002, 46(9):2268-2279.
- [12] Ribera T, Monreal L, Armengou L, et al. Synovial fluid D-dimer concentration in foals with septic joint disease[J]. J Vet Intern Med, 2011, 25(5):1113-1117.
- [13] Rodelo JR, De la Rosa G, Valencia ML, et al. D-dimer is a significant prognostic factor in patients with suspected infection and sepsis[J]. Am J Emerg Med, 2012, 30(9):1991-1999.