■探讨血清蛋白电泳(SPE)在髋关节和膝关节置换术后假体周围感染(PJI)诊断中的功效。
■回顾性调查了2013年8月至2021年1月在三级甲等医院接受髋关节和膝关节置换术的患者的病历。共纳入179例患者,分为两组:PJI组66例,无菌性松动(AL)组113例。血清C反应蛋白(CRP),红细胞沉降率(ESR),D-二聚体,纤维蛋白原,比较两组血清白蛋白及SPE中血清蛋白的比例。使用受试者工作特征(ROC)曲线确定诊断的敏感性和特异性,并使用ROC曲线下面积(AUC)比较诊断价值。
■年龄没有显著差异,PJI组与AL组之间的性别和体重指数(BMI)(P>0.05),但髋膝比值差异有统计学意义(X2=22.043,P<0.001)。CRP,ESR,D-二聚体,PJI组纤维蛋白原和α1球蛋白带比例为22.99(10.55,40.58)mg/L,37.00(23.00,61.70)mm/h,790.00(500.00,1500.00)ng/ml,4.84(3.81,5.55)g/L和5.80(5.00,7.73)%高于AL组[1.89(0.50,4.12)mg/L,U=7.984,P<0.001;10.10(7.00,16.90)mm/h,U=8.095,P<0.001;570.00(372.50,780.00)ng/ml,U=3.448,P<0.001;2.84(2.45,3.43)g/L,U=8.053,P<0.001,4.20(3.90,4.80)%,U=8.154,P<0.001]。PJI组的血清白蛋白和白蛋白条带的比例为36.10(33.10,39.00)g/L和49.00(44.95,52.20)%,低于AL组[38.10(34.00,41.10)g/L,U=-2.383,P=0.017和54.40(51.55,56.70)%,U=-6.162,P<0.001]。在PJI组中的比例,α1球蛋白比例的AUC为0.8654,相当于CRP(0.8698),ESR(0.8680),优于纤维蛋白原(0.8025)。
■SPE中α1球蛋白比例升高对TsukayamaIV型PJI具有良好的诊断价值,其准确性与ESR和CRP相当。α1球蛋白可以辅助CRP和ESR确定第二阶段修订的时机。
UNASSIGNED: To investigate the efficacy of serum protein electrophoresis (SPE) in the diagnosis of periprosthetic joint infection (PJI) after hip and knee arthroplasty.
UNASSIGNED: The medical records of patients undergoing hip and knee arthroplasty at a class A tertiary hospital between August 2013 and January 2021 were retrospectively investigated. A total of 179 patients were included and divided into two groups: 66 patients in the PJI group and 113 patients in the aseptic loosening (AL) group. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, Fibrinogen, Serum albumin and the proportion of serum protein in SPE were compared between the two groups. The diagnostic sensitivity and specificity were determined using the receiver operating characteristic (ROC) curve, and the diagnostic value was compared using the area under the ROC curve (AUC).
UNASSIGNED: There was no significant difference in age, sex and body mass index (BMI) between PJI group and AL group (P>0.05), but there was significant difference in the ratio of hip to knee (X2 = 22.043, P<0.001). The CRP, ESR, D-dimer, Fibrinogen and the proportion of α1 globulin band in PJI group was 22.99(10.55,40.58) mg/L, 37.00(23.00,61.70) mm/h, 790.00(500.00,1500.00) ng/ml, 4.84(3.81,5.55) g/L and 5.80(5.00,7.73) % which was higher than that in AL group [1.89(0.50,4.12) mg/L, U=7.984, P<0.001; 10.10(7.00,16.90) mm/h, U=8.095, P<0.001; 570.00(372.50,780.00) ng/ml, U=3.448, P<0.001; 2.84(2.45,3.43) g/L, U=8.053, P<0.001 and 4.20(3.90,4.80) %, U=8.154, P<0.001]. The Serum albumin and the proportion of Albumin band in PJI group was 36.10(33.10,39.00) g/L and 49.00(44.95,52.20) % which was lower than that in AL group [38.10(34.00,41.10) g/L, U=-2.383, P=0.017 and 54.40(51.55,56.70) %, U=-6.162, P<0.001]. The proportion of In PJI group, the AUC of proportion of α1 globulin was 0.8654, which was equivalent to CRP (0.8698), ESR (0.8680) and outperformed that of fibrinogen (0.8025).
UNASSIGNED: Elevated proportion of α1 globulin in SPE presented with good diagnostic value for Tsukayama type IV PJI, and its accuracy was comparable to those of ESR and CRP. And α1 globulin can assist with CRP and ESR to determining the timing of second-stage revision.