The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection A Systematic Review and Meta-Analysis
The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection A Systematic Review and Meta-Analysis
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DOI：
10.2106/jbjs.15.01142
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发表时间：
2016-06-15
影响因子：
5.3
通讯作者：
Blom, A. W.
中科院分区：
文献类型：
--
作者：
Wyatt, M. C.;Beswick, A. D.;Blom, A. W.
背景：滑膜生物标志物最近被用作假体周围关节感染(PJI)的诊断工具，但其实用性尚不确定。本系统综述和荟萃分析的目的是将α-防御素免疫分析和白细胞酯酶比色条试验诊断PJI的准确性与肌肉骨骼感染学会的诊断标准进行比较。方法：我们对评价α-防御素或白细胞酯酶诊断PJI准确性的诊断技术研究进行系统综述。检索了Medline和Embase on Ovid、ACM、ADS、arxiv、CERN DS(Conseil Europe En Pour La Recherche Nucleaire Document Server)、CrossRef DOI(Digital Object ID)、DBLP(Digital书目与图书馆项目)、Espace enet、Google Scholar、Gutenberg、Highwire、IEEE Xplore(电气电子工程师学会数字图书馆)、INSPIRE、JSTOR(期刊存储)、OALSTER(元数据收集开放档案倡议协议)、Open Content、Pubget、PubMed和Web of Science，以及未发表或灰色文献。研究的分类和数据提取由2名评价者独立完成。数据提取允许通过构建每个测试的接收者操作特征曲线来进行灵敏度和特异度的荟萃分析。结果：我们纳入了11项合格研究。α-防御素对PJI诊断的敏感性和特异性分别为1.00(95%可信区间0.82~1.00)和0.96(95%CI 0.89~0.99)。α-防御素和PJI的曲线下面积(AUC)为0.99(95%CI，0.98~1.00)。白细胞酯酶对PJI的综合诊断敏感性和特异性分别为0.81(95%CI，0.49~0.95)和0.97(95%CI，0.82~0.99)。白细胞酯酶和PJI的AUC分别为0.97(95%CI，0.95~0.98)。结论：PJI对两种诊断试验的诊断准确率都很高。考虑到研究的数量有限，而且两种测试之间的成本差异很大，有必要对这些测试进行更多的独立研究。
Background: Synovial biomarkers have recently been adopted as diagnostic tools for periprosthetic joint infection (PJI), but their utility is uncertain. The purpose of this systematic review and meta-analysis was to synthesize the evidence on the accuracy of the alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of PJI compared with the Musculoskeletal Infection Society diagnostic criteria.Methods: We performed a systematic review to identify diagnostic technique studies evaluating the accuracy of alpha-defensin or leukocyte esterase in the diagnosis of PJI. MEDLINE and Embase on Ovid, ACM, ADS, arXiv, CERN DS (Conseil Europeen pour la Recherche Nucleaire Document Server), CrossRef DOI (Digital Object Identifier), DBLP (Digital Bibliography & Library Project), Espacenet, Google Scholar, Gutenberg, HighWire, IEEE Xplore (Institute of Electrical and Electronics Engineers digital library), INSPIRE, JSTOR (Journal Storage), OAlster (Open Archives Initiative Protocol for Metadata Harvesting), Open Content, Pubget, PubMed, and Web of Science were searched for appropriate studies indexed from inception until May 30, 2015, along with unpublished or gray literature. The classification of studies and data extraction were performed independently by 2 reviewers. Data extraction permitted meta-analysis of sensitivity and specificity with construction of receiver operating characteristic curves for each test.Results: We included 11 eligible studies. The pooled diagnostic sensitivity and specificity of alpha-defensin (6 studies) for PJI were 1.00 (95% confidence interval [CI], 0.82 to 1.00) and 0.96 (95% CI, 0.89 to 0.99), respectively. The area under the curve (AUC) for alpha-defensin and PJI was 0.99 (95% CI, 0.98 to 1.00). The pooled diagnostic sensitivity and specificity of leukocyte esterase (5 studies) for PJI were 0.81 (95% CI, 0.49 to 0.95) and 0.97 (95% CI, 0.82 to 0.99), respectively. The AUC for leukocyte esterase and PJI was 0.97 (95% CI, 0.95 to 0.98). There was substantial heterogeneity among studies for both diagnostic tests.Conclusions: The diagnostic accuracy for PJI was high for both tests. Given the limited number of studies and the large cost difference between the tests, more independent research on these tests is warranted.