背景:假体周围关节感染(PJI)是全关节置换术(TJA)后可能发生的严重并发症。PJI的及时准确诊断是治疗的关键。本研究探讨了血小板与淋巴细胞比值(PLR)的诊断价值。血小板计数与平均血小板体积比(PVR),全膝关节置换术(TKA)和全髋关节置换术(THA)后PJI的中性粒细胞与淋巴细胞比率(NLR)和单核细胞与淋巴细胞比率(MLR)。
方法:我们对2015年6月至2020年6月在我们研究所接受髋关节或膝关节置换术的患者进行了回顾性分析。在接受检查的187名患者中,168人被纳入研究。根据肌肉骨骼感染协会(MSIS)的诊断标准,58例患者为PJI组,110例患者为无菌性松动(AL)组。我们记录并比较术前外周血白细胞(WBC)计数,血小板计数(PLT),红细胞沉降率(ESR),C反应蛋白(CRP),PLR,PVR,NLR,和MLR在两组中。WBC的诊断性能,PLT,PLR,PVR,NLR,和MLR单独和结合ESR和CRP用于PJI诊断通过受试者工作特征(ROC)曲线进行评估,和灵敏度,特异性,正预测值,并计算阴性预测值。
结果:与AL组相比,平均WBC,PLT,ESR,CRP,PLR,PVR,NLR,PJI组外周血MLR显著年夜(P<0.05)。ROC曲线分析表明,CRP,PLR,PVR,NLR,外周血MLR对诊断PJI有中等疗效,曲线下面积(AUC)值为0.760(95%CI:0.688-0.823),0.758(95%CI:0.687-0.821),0.714(95%CI:0.639-0.781),0.709(95%CI:0.634-0.777),0.723(95%CI:0.649-0.789),和0.728(95%CI:0.654-0.793),分别。相反,白细胞和血小板计数对PJI的诊断价值较差,AUC值为0.578(95%CI:0.499-0.653)和0.694(95%CI:0.619-0.763),分别。预测模型计算结果表明,WBC的综合AUC,PLT,ESR,CRP,PLR,PVR,NLR,MLR最高,为0.853(95%CI,0.790-0.909),表明在PJI的诊断中具有良好的价值,敏感性为82.8%,特异性为72.7%。此外,与传统生物标志物ESR和CRP相比,新的参数组合提高了PJI诊断的准确性和可靠性(P=0.015).
结论:我们的研究表明,外周血生物标志物PLR的诊断价值,PVR,NLR,和MLR对PJI的诊断是有限的,并不优于ESR或CRP。然而,当WBC,PLT,ESR,CRP,PLR,PVR,NLR,和MLR结合在一起,PJI在TJA患者中的诊断表现可以得到改善。
BACKGROUND: Periprosthetic joint infection (PJI) is a severe complication that can occur after total joint arthroplasty (TJA). The timely and accurate diagnosis of PJI is the key to treatment. This
study investigated the diagnostic value of platelet to lymphocyte ratio (PLR), platelet count to mean platelet volume ratio (PVR), neutrophil to lymphocyte ratio (NLR) and monocyte to lymphocyte ratio (MLR) in PJI after total knee arthroplasty (TKA) and total hip arthroplasty (THA).
METHODS: We performed a retrospective analysis of the patients who underwent revision hip or knee arthroplasty at our Institute between June 2015 and June 2020. Of the 187 patients reviewed, 168 were included in the
study. According to the diagnostic criteria of the Musculoskeletal Infection Society (MSIS), 58 patients were in the PJI group, and 110 patients were in the aseptic loosening (AL) group. We recorded and compared the preoperative peripheral blood white blood cell (WBC) count, platelet count (PLT), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), PLR, PVR, NLR, and MLR in both groups. The diagnostic performance of the WBC, PLT, PLR, PVR, NLR, and MLR individually and in combination with the ESR and CRP for PJI diagnosis was evaluated by receiver operating characteristic (ROC) curves, and the sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
RESULTS: Compared to those in the AL group, the mean WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR in the peripheral blood of the PJI group were significantly greater (P < 0.05). The analysis of the ROC curve revealed that the ESR, CRP, PLR, PVR, NLR, and MLR in peripheral blood had moderate effectiveness in diagnosing PJI, with area under the curve (AUC) values of 0.760 (95% CI: 0.688-0.823), 0.758 (95% CI: 0.687-0.821), 0.714 (95% CI: 0.639-0.781), 0.709 (95% CI: 0.634-0.777), 0.723 (95% CI: 0.649-0.789), and 0.728 (95% CI: 0.654-0.793), respectively. Conversely, the WBC and PLT counts demonstrated poor diagnostic value for PJI, with AUC values of 0.578 (95% CI: 0.499-0.653) and 0.694 (95% CI: 0.619-0.763), respectively. The results of the prediction model calculations revealed that the combined AUC of the WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR was the highest at 0.853 (95% CI, 0.790-0.909), indicating good value in the diagnosis of PJI, with a sensitivity of 82.8% and a specificity of 72.7%. Moreover, the novel composite of parameters improved the accuracy and reliability in diagnosing PJI compared to the traditional biomarkers ESR and CRP (P = 0.015).
CONCLUSIONS: Our
study suggested that the diagnostic value of the peripheral blood biomarkers PLR, PVR, NLR, and MLR for diagnosing PJI is limited and not superior to that of the ESR or CRP. However, when the WBC, PLT, ESR, CRP, PLR, PVR, NLR, and MLR are combined, the diagnostic performance of PJI in TJA patients can be improved.