关节液白介素-4在慢性膝关节假体周围感染诊断中的价值研究

家兴 黄(重庆医科大学附属第一医院骨科，中国)
力 魏(重庆医科大学附属第一医院骨科，中国)
博 朱(重庆医科大学附属第一医院骨科，中国)
伟 黄(重庆医科大学附属第一医院骨科，中国)
宁 胡(重庆医科大学附属第一医院骨科，中国)

摘要

目的：研究关节液白介素-4在慢性膝关节假体周围感染诊断中的价值，制定最佳诊断截断值。方法：前瞻性地纳入于2019年2月至2021年9月因膝关节慢性假体周围感染或无菌性失败行翻修手术治疗的患者。术前测试血清红细胞沉降率、C反应蛋白、白介素-6及关节液白介素-4、白细胞计数。ROC曲线分析各指标对慢性膝关节假体周围感染的诊断价值，计算最佳截断值。结果：共纳入32例膝关节慢性假体周围感染患者及25例无菌性失败患者。慢性PJI组中各指标均明显高于无菌性失败组（P＜0.05）。ROC曲线分析显示关节液白介素-4＞1.54pg/mL时较其他研究指标对膝关节慢性假体周围感染具有最高的诊断价值（P＜0.05）。结论：关节液白介素-4对慢性膝关节假体周围感染诊断有更佳的临床应用价值。

关键词

慢性假体周围感染；膝关节；白细胞介素-4；诊断

参考

Delanois RE, Mistry JB, Gwam CU, et al. Current Epidemiology of Revision Total Knee Arthroplasty in the United States. [J]. J Arthroplasty. 2017,32(9):2663-2668.

AKGÜN D, MÜLLER M, PERKA C, et al. The serum level of C-reactive protein alone cannot be used for the diagnosis of prosthetic joint infections, especially in those caused by organisms of low virulence [J]. Bone Joint J, 2018,100-B(11):1482-1486.

PARVIZI J, GEHRKE T. Definition of periprosthetic joint infection [J]. Arthroplasty, 2014,29(7):1331.

Osmon D R, Berbari E F, Berendt A R, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America [J]. Clin Infect Dis, 2013,56(1):1-25.

Boddapati V, Fu M C, Mayman D J, et al. Revision Total Knee Arthroplasty for Periprosthetic Joint Infection Is Associated With Increased Postoperative Morbidity and Mortality Relative to Noninfectious Revisions [J]. J Arthroplasty,2018,33(2):521-526.

Bingham J S, Hassebrock J D, Christensen A L, et al. Screening for Periprosthetic Joint Infections With ESR and CRP: The Ideal Cutoffs [J]. J Arthroplasty,2020,35(5):1351-1354.

Ghanem E, Parvizi J, Burnett R S J, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty [J]. J Bone Joint Surg Am,2008,90(8):1637-1643.

Zmistowski B, Restrepo C, Huang R, et al. Periprosthetic joint infection diagnosis: a complete understanding of white blood cell count and differential [J]. J Arthroplasty, 2012,27(9):1589-1593.

Shahi A, Deirmengian C, Higuera C, et al. Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection [J]. Clin Orthop Relat Res,2015,473(7):2244-2249.

Sukhonthamarn K, Tan T L, Xu C, et al. Determining Diagnostic Thresholds for Acute Postoperative Periprosthetic Joint Infection [J]. J Bone Joint Surg Am,2020,102(23):2043-2048.

Dinarello C A. Proinflammatory cytokines [J]. Chest, 2000,118(2):503-508.

Gollwitzer H, Dombrowski Y, Prodinger P M, et al. Antimicrobial peptides and proinflammatory cytokines in periprosthetic joint infection [J]. Bone Joint Surg Am,2013,95(7):644-651.

Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis [J]. Bone Joint Surg Am, 2010,92(11):2102-2109.

Ettinger M, Calliess T, Kielstein J T, et al. Circulating biomarkers for discrimination between aseptic joint failure, low-grade infection, and high-grade septic failure [J]. Clin Infect Dis, 2015,61(3):332-341.

Qin L, Li X, Wang J, et al. Improved diagnosis of chronic hip and knee prosthetic joint infection using combined serum and synovial IL-6 tests [J]. Bone Joint Res,2020,9(9):587-592.

HO I C, MIAW S C. Regulation of IL-4 Expression in Immunity and Diseases [J]. Adv Exp Med Biol, 2016,941(7):31-77.

Pesanti E L, LORENZO J A. Osteoclasts and effects of interleukin 4 in development of chronic osteomyelitis [J]. Clin Orthop Relat Res,1998(355):290-299.

Prabhakara R, Harro J M, LEID J G, et al. Suppression of the inflammatory immune response prevents the development of chronic biofilm infection due to methicillin-resistant Staphylococcus aureus [J]. Infect Immun,2011,79(12):5010-5018.

Fröschen F S, Schell S, Schildberg F A, et al. Analysis of synovial biomarkers with a multiplex protein microarray in patients with PJI undergoing revision arthroplasty of the hip or knee joint [J]. Arch Orthop Trauma Surg, 2020,140(12):1883-1890.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v4i12.9760