Different diagnostic properties of C-reactive protein, real-time PCR, and histopathology of frozen and permanent sections in diagnosis of periprosthetic joint infection.
Different diagnostic properties of C-reactive protein, real-time PCR, and histopathology of frozen and permanent sections in diagnosis of periprosthetic joint infection.
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DOI：
10.3109/17453674.2013.862460
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发表时间：
2013-12
影响因子：
3.7
通讯作者：
Saito T
中科院分区：
文献类型：
--
作者：
Miyamae Y;Inaba Y;Kobayashi N;Choe H;Yukizawa Y;Ike H;Saito T
有几个诊断测试假体周围关节感染（PJI）。我们评估了术前血清C反应蛋白（CRP），实时聚合酶链反应（PCR），冷冻和永久切片的组织病理学评价与培养阳性PJI的临床病例的属性。对86例手术患者的63个关节进行术前血清CRP检测，并在术中采集组织标本进行实时荧光定量PCR和组织病理学检查。我们计算了灵敏度、特异性、阳性检测结果的似然比（PLR）和阴性检测结果的似然比（NLR），以阳性微生物培养结果作为金标准。血清CRP诊断的敏感性和特异性分别为90%和85%。冷冻和石蜡组织切片的实时PCR和组织病理学的相应值分别为90%和45%，71%和89%，以及90%和87%。血清CRP的PLR为5.8，NLR为0.12，实时PCR的PLR为1.6，NLR为0.18。冷冻组织切片的相应值分别为6.6和0.32，石蜡切片的相应值分别为7.1和0.11。结果表明，实时PCR和冰冻切片组织病理学是一个很好的结合。前者敏感性高，NLR好，适合于筛查;后者特异性好，PLR好，适合于感染的确诊。
There are several diagnostic tests for periprosthetic joint infection (PJI). We evaluated the properties of preoperative serum C-reactive protein (CRP), real-time polymerase chain reaction (PCR), and histopathological evaluation of frozen and permanent sections in clinical cases with culture-positive PJI. 63 joints involving 86 operations were analyzed using serum CRP measurement prior to operation and tissue samples were collected intraoperatively for real-time PCR and histopathology. We calculated the sensitivity, specificity, likelihood ratio of positive test results (PLR), and likelihood ratio of negative test results (NLR) for each test in relation to positive microbiological culture results as the gold standard. The sensitivity and specificity of diagnosis with serum CRP were 90% and 85%, respectively. The corresponding values for real-time PCR and histopathology of frozen and paraffin tissue sections were 90% and 45%, 71% and 89%, and 90% and 87%, respectively. Serum CRP had a PLR of 5.8 and an NLR of 0.12, and real-time PCR had a PLR of 1.6 and an NLR of 0.18. The corresponding figures for frozen tissue sections were 6.6 and 0.32, and those for paraffin sections were 7.1 and 0.11, respectively. The results suggest that real-time PCR and histopathology of frozen sections is a good combination. The former is suitable for screening, with its high sensitivity and good NLR, while the latter is suitable for definitive diagnosis of infection, with its excellent specificity and good PLR.