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IF 1.6 4区医学 Q3 ORTHOPEDICS

Knee Pub Date : 2025-03-19 DOI:10.1016/j.knee.2025.02.027

Zirvecan Güneş , Mehmet Kürşat Yılmaz , Bahattin Kemah , Ömür Çağlar , Ahmet Mazhar Tokgözoğlu , Javad Parvizi , İbrahim Azboy , Bülent Atilla

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引用次数: 0

摘要

背景：尽管有许多检查和指南，但诊断假体周围关节感染（PJI）仍具有挑战性。本研究旨在确定滑膜 D-二聚体而非血清在诊断 PJI 中的价值：这项前瞻性研究招募了 17 名慢性膝关节 PJI 患者（PJI 组）和 52 名原发性膝关节骨关节炎患者（对照组）。PJI采用2018年国际共识会议标准进行定义。测定了滑膜D-二聚体、血浆D-二聚体、血清红细胞沉降率和血清C反应蛋白水平。使用酶联荧光测定法测定滑膜液 D-二聚体水平。使用接收器操作特征曲线（ROC）评估了每种生物标记物诊断 PJI 的性能：结果：PJI 组滑膜 D-二聚体水平中位数（927 095 ng/ml，IQR 566 882-1215 066）明显高于对照组（20 954 ng/ml，IQR 10 350-46 493）（P 结论：PJI 组滑膜 D-二聚体水平中位数（927 095 ng/ml，IQR 566 882-1215 066）明显高于对照组（20 954 ng/ml，IQR 10 350-46 493）：慢性膝关节PJI患者的滑膜D-二聚体水平明显偏高，这表明纤溶活性的增加与感染引起的炎症反应同时存在。滑膜 D-二聚体水平似乎是诊断 PJI 的重要生物标志物。然而，还需要进一步的研究来评估这种新型生物标志物的作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Synovial D-dimer is a novel and accurate test for diagnosis of chronic knee periprosthetic joint infection

Background

Despite numerous tests and guidelines, diagnosing periprosthetic joint infection (PJI) remains challenging. The study aimed to determine the value of synovial D-dimer, rather than serum, in diagnosing PJI.

Methods

This prospective study enrolled 17 patients with chronic knee PJI (the PJI group) and 52 with primary knee osteoarthritis (the control group). PJI was defined using the 2018 International Consensus Meeting Criteria. Synovial D-dimer, plasma D-dimer, serum erythrocyte sedimentation rate, and serum C-reactive protein levels were measured. Synovial fluid D-dimer levels were determined using an enzyme-linked fluorescence assay. The performance of each biomarker in diagnosing PJI was evaluated using receiver operating characteristic (ROC) curves.

Results

The median synovial D-dimer level was significantly higher in the PJI group at (927,095 ng/ml, IQR 566,882–1,215,066) than in the control group (20,954 ng/ml, IQR 10,350–46,493) (P < 0.001). When the synovial D-dimer threshold value was determined to be 236,804 ng/ml, the sensitivity was 100% (CI 93.2–100%), and the specificity was 94.12% (95% CI 71.3–99.9). The area under the curve determined by ROC analysis was 0.992 (95% CI 0.992–1.000, P < 0.0001).

Conclusions

Patients with chronic knee PJI have significantly high synovial D-dimer levels, demonstrating that an increase in fibrinolytic activity coexists with an infection-induced inflammatory response. Synovial D-dimer levels appear to be valuable biomarkers for diagnosing PJI. However, further studies are required to evaluate the role of this novel biomarker.

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来源期刊

Knee 医学-外科

CiteScore

3.80

自引率

5.30%

发文量

171

审稿时长

6 months

期刊介绍： The Knee is an international journal publishing studies on the clinical treatment and fundamental biomechanical characteristics of this joint. The aim of the journal is to provide a vehicle relevant to surgeons, biomedical engineers, imaging specialists, materials scientists, rehabilitation personnel and all those with an interest in the knee. The topics covered include, but are not limited to: • Anatomy, physiology, morphology and biochemistry; • Biomechanical studies; • Advances in the development of prosthetic, orthotic and augmentation devices; • Imaging and diagnostic techniques; • Pathology; • Trauma; • Surgery; • Rehabilitation.