人工关节假体周围感染诊断生物标志物研究进展

doi:10.3969/j.issn.1673-8640.2023.10.017

摘要/Abstract

摘要：

人工关节假体周围感染（PJI）需要及时、准确的诊断，但目前的诊断标准并不能识别所有级别的感染。在病史和体格检查明确的情况下，C反应蛋白等传统生物标志物仍然作为诊断假体周围感染的首选指标被广泛使用。然而，随着对假体周围感染研究的深入，新的生物标志物及其相关检测技术不断出现，对假体周围感染的诊断效能不断提高。文章对假体周围感染相关生物标志物及其检测技术的研究进展进行综述。

关键词: 关节假体周围感染, 生物标志物, 检测技术

Abstract:

Periprosthetic joint infection（PJI） requires timely and accurate diagnosis，and current diagnostic criteria can not 100% identify all grades of infection. Traditional biomarkers，such as C-reactive protein，are still widely used as the first choice for diagnosing periprosthetic infection，when history and physical examination are clear. However，with the research on periprosthetic infection，new biomarkers and determination technologies continue to emerge，making the diagnosis of periprosthetic infection continue to improve. This review focuses on the research progress of periprosthetic infection-related biomarkers and determination technologies.

Key words: Periprosthetic joint infection, Biomarker, Determination technology

中图分类号:

R446.1

鲁启源, 卢建华. 人工关节假体周围感染诊断生物标志物研究进展[J]. 检验医学, 2023, 38(10): 997-1002.

LU Qiyuan, LU Jianhua. Biomarker research progress for the diagnosis of periprosthetic joint infection[J]. Laboratory Medicine, 2023, 38(10): 997-1002.

参考文献 40

[1]	AHMED S S, YAGHMOUR K M, HADDAD F S. The changing face of infection,diagnosis,and management in the United Kingdom[J]. Orthop Clin North Am, 2020, 51(2):141-146. DOI URL
[2]	GOSWAMI K, PARVIZI J, MAXWELL COURTNEY P. Current recommendations for the diagnosis of acute and chronic PJI for hip and knee-cell counts,alpha-defensin,leukocyte esterase,next-generation sequencing[J]. Curr Rev Musculoskelet Med, 2018, 11(3):428-438. DOI
[3]	PARVIZI J, ZMISTOWSKI B, BERBARI E F, et al. New definition for periprosthetic joint infection:from the workgroup of the Musculoskeletal Infection Society[J]. Clin Orthop Relat Res, 2011, 469(11):2992-2994. DOI URL
[4]	PARVIZI J, TAN T L, GOSWAMI K, et al. The 2018 definition of periprosthetic hip and knee infection:an evidence-based and validated criteria[J]. J Arthroplasty, 2018, 33(5):1309-1314. DOI URL
[5]	中华医学会骨科学分会关节外科学组《中国PJI诊断和治疗指南》编写委员会. 中国人工关节感染诊断与治疗指南[J]. 中华外科杂志, 2021, 59(6):430-442.
[6]	PAZIUK T, RONDON A J, GOSWAMI K, et al. A novel adjunct indicator of periprosthetic joint infection:platelet count and mean platelet volume[J]. J Arthroplasty, 2020, 35(3):836-839. DOI URL
[7]	SALEH A, GEORGE J, FAOUR M, et al. Serum biomarkers in periprosthetic joint infections[J]. Bone Joint Res, 2018, 7(1):85-93. DOI PMID
[8]	AKGÜN D, MÜLKER 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. DOI URL
[9]	SIGMUND I K, HOLINKA J, STAATS K, et al. Inferior performance of established and novel serum inflammatory markers in diagnosing periprosthetic joint infections[J]. Int Orthop, 2021, 45(4):837-846. DOI PMID
[10]	CARLI A V, ABDELBARY H, AHMADZAI N, et al. Diagnostic accuracy of serum,synovial,and tissue testing for chronic periprosthetic joint infection after hip and knee replacements:asystematic review[J]. J Bone Joint Surg Am, 2019, 101(7):635-649. DOI URL
[11]	RONDE-OUSTAU C, DIESINGER Y, JENNY J Y, et al. Diagnostic accuracy of intra-articular C-reactive protein assay in periprosthetic knee joint infection-a preliminary study[J]. Orthop Traumatol Surg Res, 2014, 100(2):217-220. DOI URL
[12]	WANG H, QIN L, WANG J, et al. Combined serum and synovial C-reactive protein tests:a valuable adjunct to the diagnosis of chronic prosthetic joint infection[J]. BMC Musculoskelet Disord, 2021, 22(1):670. DOI
[13]	NANA A, NELSON S B, MCLAREN A, et al. What's new in musculoskeletal infection:update on biofilms[J]. J Bone Joint Surg Am, 2016, 98(14):1226-1234. DOI URL
[14]	ABDELBARY H, CHENG W, AHMADZAI N, et al. Combination tests in the diagnosis of chronic periprosthetic joint infection:systematic review and development of a stepwise clinical decision-making tool[J]. J Bone Joint Surg Am, 2020, 102(Suppl 2):114-124. DOI URL
[15]	LAZARIDES A L, VOVOS T J, REDDY G B, et al. Traditional laboratory markers hold low diagnostic utility for immunosuppressed patients with periprosthetic joint infections[J]. J Arthroplasty, 2019, 34(7):1441-1445. DOI PMID
[16]	HU B, YANG Y, ZHAO C, et al. Accuracy of neutrophil CD64 expression in diagnosing infection in patients with autoimmune diseases:a meta-analysis[J]. Clin Rheumatol, 2019, 38(5):1319-1328. DOI
[17]	SALEH A, GEORGE J, FAOUR M, et al. Serum biomarkers in periprosthetic joint infections[J]. Bone Joint Res, 2018, 7(1):85-93. DOI PMID
[18]	QIN L, HU N, LI X, et al. Evaluation of synovial fluid neutrophil CD64 index as a screening biomarker of prosthetic joint infection[J]. Bone Joint J, 2020, 102-B(4):463-469. DOI PMID
[19]	JUBEL J M, RANDAU T M, BECKER-GOTOT J, et al. sCD28,sCD80,sCTLA-4,and sBTLA are promising markers in diagnostic and therapeutic approaches for aseptic loosening and periprosthetic joint infection[J]. Front Immunol, 2021, 12:687065. DOI URL
[20]	SUEN K, KEEKA M, AILABOUNI R, et al. Synovasure 'quick test' is not as accurate as the laboratory-based α-defensin immunoassay:a systematic review and metaanalysis[J]. Bone Joint J, 2018, 100-B(1):66-72. DOI URL
[21]	SIGMUND I K, HOLINKA J, GAMPER J, et al. Qualitative α-defensin test(synovasure) for the diagnosis of periprosthetic infection in revision total joint arthroplasty[J]. Bone Joint J, 2017, 99-B(1):66-72. DOI URL
[22]	RENZ N, YERMAK K, PERKA C, et al. Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection:not a screening but a confirmatory test[J]. J Bone Joint Surg Am, 2018, 100(9):742-750. DOI URL
[23]	BALATO G, DE MATTEO V, ASCIONE T, et al. Laboratory-based versus qualitative assessment of α-defensin in periprosthetic hip and knee infections:a systematic review and meta-analysis[J]. Arch Orthop Trauma Surg, 2020, 140(3):293-301. DOI
[24]	DEIRMENGIAN C, FEELEY S, KAZARIAN G S, et al. Synovial fluid aspirates diluted with saline or blood reduce the sensitivity of traditional and contemporary synovial fluid biomarkers[J]. Clin OrthopRelat Res, 2020, 478(8):1805-1813.
[25]	BONANZINGA T, ZAHAR A, DÜTSCH, et al. How reliable is the alpha-defensin immunoassay test for diagnosing periprosthetic joint infection? A prospective study[J]. Clin OrthopRelat Res, 2017, 475(2):408-415.
[26]	STONE W Z, GRAY C F, PARVATANENI H K, et al. Clinical evaluation of synovial alpha defensin and synovial C-reactive protein in the diagnosis of periprosthetic joint infection[J]. J Bone Joint Surg Am, 2018, 100(14):1184-1190. DOI PMID
[27]	SIGMUND I K, YERMAK K, PERKA C, et al. Is the enzyme-linked immunosorbent assay more accurate than the lateral flow alpha defensin test for diagnosing periprosthetic joint infection[J]. Clin OrthopRelat Res, 2018, 476(8):1645-1654.
[28]	KLEISS S, JANDL N M, NOVO DE OLIVEIRA A, et al. Diagnostic accuracy of alpha-defensin enzyme-linked immunosorbent assay in the clinical evaluation of painful hip and knee arthroplasty with possible prosthetic joint infection:a prospective study of 202 cases[J]. Bone Joint J, 2019, 101-B(8):970-977. DOI URL
[29]	IORIO R, VIGLIETTA E, MAZZA D, et al. Accuracy and cost-effectivenss of a novel method for alpha defensins measurement in the diagnosis of periprosthetic joint infections[J]. J Arthroplasty, 2021, 36(9):3275-3281. DOI URL
[30]	KELLY M P, DARRITH B, HANNON C P, et al. Synovial fluid alpha-defensin is an adjunctive tool in the equivocal diagnosis of periprosthetic joint infection[J]. J Arthroplasty, 2018, 33(11):3537-3540. DOI PMID
[31]	AMANATULLAH D F, CHENG R Z, HUDDLESTON LII J I, et al. The routine use of synovial alpha-defensin is not necessary[J]. Bone Joint J, 2020, 102-B(5):593-599. DOI PMID
[32]	COOPER K B, SIEGEL E R, STAMBOUGH J B, et al. The alpha-defensin prosthetic joint infection test has poor validity for native knee joint infection[J]. J Arthroplasty, 2021, 36(8):2957-2961. DOI URL
[33]	MELICHERÍK P, KLAPKOVÁ E, KOTAŠKA K, et al. High-performance liquid chromatography as a novel method for the determination of α-defensins in synovial fluid for diagnosis of orthopedic infections[J]. Diagnostics(Basel), 2020, 10(1):33.
[34]	ZAGRA L, VILLA F, CAPPELLETTI L, et al. Can leucocyte esterase replace frozen sections in the intraoperative diagnosis of prosthetic hip infection[J]. Bone Joint J, 2019, 101-B(4):372-377. DOI URL
[35]	YERMAK K, KARBYSHEVA S, PERKA C, et al. Performance of synovial fluid D-lactate for the diagnosis of periprosthetic joint infection:a prospective observational study[J]. J Infect, 2019, 79(2):123-129. DOI URL
[36]	MAJORA I, JAGADALE V S. Serum interleukin 6 could be a valuable initial diagnostic tool in prosthetic knee joint infections[J]. Eur J Orthop Surg Traumatol, 2019, 29(8):1781-1788. DOI PMID
[37]	FILLEROVA R, GALLO J, RADVANSKY M, et al. Excellent diagnostic characteristics for ultrafast gene profiling of DEFA1-IL1B-LTF in detection of prosthetic joint infections[J]. J Clin Microbiol, 2017, 55(9):2686-2697. DOI URL
[38]	SOUSA R, SERRANO P, GOMES DIAS J, et al. Improving the accuracy of synovial fluid analysis in the diagnosis of prosthetic joint infection with simple and inexpensive biomarkers:C-reactive protein and adenosine deaminase[J]. Bone Joint J, 2017, 99-B(3):351-357. DOI URL
[39]	OMAR M, KLAWONN F, BRAMD S, et al. Transcriptome-wide high-density microarray analysis reveals differential gene transcription in periprosthetic tissue from hips with chronic periprosthetic joint infection vs aseptic loosening[J]. J Arthroplasty, 2017, 32(1):234-240. DOI PMID
[40]	WORTHINGTON T, DUNLOP D, CASEY A, et al. Serum procalcitonin,interleukin-6,soluble intercellular adhesin molecule-1 and IgG to short-chain exocellular lipoteichoic acid as predictors of infection in total joint prosthesis revision[J]. Br J Biomed Sci, 2010, 67(2):71-76. DOI URL