Diagnostic Accuracy of Neutrophil-Derived Circulating Free DNA (cf-DNA/NETs) for Septic Arthritis
Diagnostic Accuracy of Neutrophil-Derived Circulating Free DNA (cf-DNA/NETs) for Septic Arthritis
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DOI：
10.1002/jor.20911
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发表时间：
2009-11-01
影响因子：
2.8
通讯作者：
Jaeger, Marcus
中科院分区：
文献类型：
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作者：
Loegters, Tim;Paunel-Goerguelue, Adnana;Jaeger, Marcus
“中性粒细胞胞外陷阱”（NETs）的释放已被鉴定为先天免疫中的一种新型免疫应答。NET由嗜中性粒细胞衍生的循环游离DNA（cf-DNA）和嗜中性粒细胞胞质衍生的蛋白质如蛋白酶组成。在这项研究中，我们分析了滑膜cf-DNA/NETs识别脓毒性关节炎的推定诊断价值。纳入了42例接受关节穿刺术的关节积液患者。从滑液中，直接定量cf-DNA/NET（j-cf-DNA）水平。将j-cf-DNA的诊断价值与白色血细胞（WBC）、滑膜白色血细胞（j-WBC）、C反应蛋白（CRP）、j-IL-6、j-TNF α、j-IL-1 β和髓过氧化物酶（j-MPO）进行比较。计算每个参数的灵敏度、特异性、阳性和阴性预测值以及ROC曲线。脓毒性关节炎患者的滑液cf-DNA/NETs值（3，286 +/- 386 ng/ml，n = 9）与非感染性关节炎患者（1，040 208 ng/ml，n = 17）或骨关节炎患者（278 +/- 34 ng/ml，n = 16，p < 0.01）相比显著增加。联合应用j-cf-DNA后，j-IL-6和j-IL-1 β明显升高（P < 0.01），而WBC、CRP和j-WBC无明显升高。在300 ng/ml的临界值下，j-cf-DNA的灵敏度为0.89，特异性为1.0，阳性预测值为1.0，阴性预测值为0.97。受试者操作曲线显示cf-DNA/NET（0.933）和j-IL-6（0.951）的曲线下面积最大。cf-DNA/NET似乎是诊断脓毒性关节炎或假体周围感染的有价值的额外标记物。然而，这一结果需要在大型临床试验中得到证实。(C)2009骨科研究学会。出版社：Wiley Periodicals，Inc. J Orthop Res 27：1401-1407，2009
The release of "neutrophil extracellular traps" (NETs) has been identified as a novel immune response in innate immunity. NETs are composed of neutrophil-derived circulating free DNA (cf-DNA) and neutrophil cytoplasm-derived proteins such as proteases. In this study, we analyzed the putative diagnostic value of synovial cf-DNA/NETs for identification of septic arthritis. Forty-two patients with a joint effusion who had undergone arthrocentesis were included. From synovial fluid, cf-DNA/NETs (j-cf-DNA) levels were directly quantified. Diagnostic value of j-cf-DNA was compared with white blood cells (WBC), synovial white blood cells (j-WBC), C-reactive protein (CRP), j-IL-6, j-TNF alpha, j-IL-1 beta, and myeloperoxidase (j-MPO). Sensitivity, specificity, positive and negative predictive value, as well as ROC-curves for each parameter were calculated. Synovial fluid cf-DNA/NETs values from patients with septic arthritis (3,286 +/- 386 ng/ml, n = 9) were significantly increased compared to patients with noninfectious joint inflammation (1,040 208 ng/ml, n = 17) or osteoarthritis (278 +/- 34 ng/ml, n = 16, p < 0.01). In conjunction with j-cf-DNA, j-IL-6 and j-IL-1 beta were significantly elevated (P < 0.01), but WBC, CRP, and j-WBC were not. At a cut-off of 300 ng/ml, j-cf-DNA had a sensitivity of 0.89, a specificity of 1.0, a positive predictive value of 1.0, and a negative predictive value of 0.97. Receiver operation curves revealed largest areas under the curve for cf-DNA/NETs (0.933) and j-IL-6 (0.951). cf-DNA/NETs seem to be a valuable additional marker for the diagnosis of septic arthritis or periprosthetic infections. However, this result should be confirmed in a large clinical trial. (C) 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1401-1407, 2009