Improved diagnosis of chronic hip and knee prosthetic joint infection using combined serum and synovial IL-6 tests.
Improved diagnosis of chronic hip and knee prosthetic joint infection using combined serum and synovial IL-6 tests.
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DOI：
10.1302/2046-3758.99.bjr-2020-0095.r1
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发表时间：
2020-09
影响因子：
4.6
通讯作者：
Huang W
中科院分区：
文献类型：
--
作者：
Qin L;Li X;Wang J;Gong X;Hu N;Huang W
本研究旨在探讨血清联合滑膜白细胞介素 - 6（IL - 6）检测是否可提高人工关节感染（PJI）诊断的准确性，并确定血清和滑膜液中IL - 6在检测慢性PJI时的临界值。
计划因膝关节和髋关节置换术后慢性感染或植入物无菌性松动而进行翻修手术的患者在纳入本研究前进行前瞻性筛选。采用肌肉骨骼感染协会（MSIS）对PJI的定义将病例分类为无菌性或感染性。分析血清C反应蛋白（CRP）、红细胞沉降率（ESR）、IL - 6、滑膜液中多形核中性粒细胞百分比（PMN%）以及IL - 6。进行统计学检验以比较两组中的这些生物标志物，并对每种生物标志物分析受试者工作特征（ROC）曲线和曲线下面积（AUC）。
共纳入93例患者。两组之间的人口统计学数据无差异。滑膜液IL - 6以1855.36 pg/ml为阈值，在检测慢性PJI时平均敏感度为94.59%（95%置信区间（CI）为81.8% - 99.3%），平均特异度为92.86%（95% CI为82.7% - 98.0%）。然后确定血清IL - 6诊断慢性PJI的最佳阈值为6.7 pg/ml，平均敏感度为97.30%（95% CI为85.8% - 99.9%），平均特异度为76.79%（95% CI为63.6% - 87.0%）。滑膜IL - 6和血清IL - 6联合使用可将慢性PJI诊断的准确性提高到96.77%。
本研究表明，血清IL - 6和滑膜IL - 6联合使用有可能进一步提高PJI的诊断水平。
引用本文：《骨关节研究》2020年；9(9):587 - 592
This study aimed to explore whether serum combined with synovial interleukin-6 (IL-6) measurement can improve the accuracy of prosthetic joint infection (PJI) diagnosis, and to establish the cut-off values of IL-6 in serum and synovial fluid in detecting chronic PJI. Patients scheduled to have a revision surgery for indications of chronic infection of knee and hip arthroplasties or aseptic loosening of an implant were prospectively screened before being enrolled into this study. The Musculoskeletal Infection Society (MSIS) definition of PJI was used for the classification of cases as aseptic or infected. Serum CRP, ESR, IL-6, and percentage of polymorphonuclear neutrophils (PMN%) and IL-6 in synovial fluid were analyzed. Statistical tests were performed to compare these biomarkers in the two groups, and receiver operating characteristic (ROC) curves and area under the curve (AUC) were analyzed for each biomarker. A total of 93 patients were enrolled. There was no difference in demographic data between both groups. Synovial fluid IL-6, with a threshold of 1,855.36 pg/ml, demonstrated a mean sensitivity of 94.59% (95% confidence interval (CI) 81.8% to 99.3%) and a mean specificity of 92.86% (95% CI 82.7 to 98.0) for detecting chronic PJI. Then 6.7 pg/ml was determined to be the optimal threshold value of serum IL-6 for the diagnosis of chronic PJI, with a mean sensitivity of 97.30% (95% CI 85.8% to 99.9%) and a mean specificity of 76.79% (95% CI 63.6% to 87.0%). The combination of synovial IL-6 and serum IL-6 led to improved accuracy of 96.77% in diagnosing chronic PJI. The present study identified that a combination of IL-6 in serum and synovial IL-6 has the potential for further improvement of the diagnosis of PJI. Cite this article: Bone Joint Res 2020;9(9):587–592.