文章摘要
刘铮,安浩铭,唐云皓,等.滑液中PRTN3和MNDA诊断关节假体周围感染的效能:与α-防御素的比较.骨科,2024,15(3): 224-228.
滑液中PRTN3和MNDA诊断关节假体周围感染的效能:与α-防御素的比较
Performance of Synovial Fluid PRTN3 and MNDA for Diagnosing Periprosthetic Joint Infection: Comparison with the Use of α-defensin
投稿时间:2024-03-11  
DOI:10.3969/j.issn.1674-8573.2024.03.006
中文关键词: 关节假体周围感染  生物标记物  蛋白酶3  髓样细胞核分化抗原
英文关键词: Periprosthetic joint infection  Biomarkers  PRTN3  MNDA
基金项目:国家自然科学基金(U22A20355)
作者单位E-mail
刘铮 解放军总医院第四医学中心骨科医学部北京 100048解放军医学院北京 100853国家骨科与运动康复临床医学研究中心北京 100853  
安浩铭 解放军总医院第四医学中心骨科医学部北京 100048解放军医学院北京 100853南开大学天津 300071  
唐云皓 解放军总医院第四医学中心骨科医学部北京 100048解放军医学院北京 100853国家骨科与运动康复临床医学研究中心北京 100853  
谷旺 解放军总医院第四医学中心骨科医学部北京 100048国家骨科与运动康复临床医学研究中心北京 100853  
高志森 解放军总医院第四医学中心骨科医学部北京 100048国家骨科与运动康复临床医学研究中心北京 100853  
李睿 解放军总医院第四医学中心骨科医学部北京 100048国家骨科与运动康复临床医学研究中心北京 100853 ryanlee301@163.com 
柴伟 解放军总医院第四医学中心骨科医学部北京 100048国家骨科与运动康复临床医学研究中心北京 100853 chaiweiguanjie@sina.com 
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中文摘要:
      目的 检测关节滑液中标志物蛋白酶3(proteinase 3,PRTN3)和髓样细胞核分化抗原(myeloid nuclear differentiation antigen,MNDA)在关节假体周围感染(periprosthetic joint infection,PJI)诊断中的临床效能,并与传统标志物α-defensin进行比较。方法 回顾性收集连续65例因怀疑PJI而进行髋膝关节诊断性穿刺病人的关节滑液标本。基于2014年肌肉骨骼感染协会(Musculoskeletal Infection Society,MSIS)标准,将29例纳入PJI组,36例纳入非PJI组。随后使用商用ELISA试剂盒检测关节滑液中的三种标志物水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线分析评价所研究生物标志物的诊断效能,并计算其各自的敏感度、特异度与截断值。结果 PJI组菌培养结果以葡萄球菌为主,占比31%,培养阴性病人占比34.5%。ROC分析结果显示,PRTN3的曲线下面积(area under the curve,AUC)最大,为0.984(95% CI,0.961~1.000),其次是α-defensin,AUC为0.944(95% CI,0.888~1.000),最后为MNDA,AUC为0.849(95% CI,0.755~0.943)。PRTN3的最佳截断值为318.000(ng/mL),敏感度为0.931,特异度为0.972。α-defensin的最佳截断值为7.150(μg/mL),敏感度为0.931,特异度为0.861。MNDA的最佳截断值为4.318(ng/mL),敏感度为0.862,特异度为0.722。结论 PRTN3和MNDA都是PJI的优秀生物标志物。PRTN3的诊断性能最好,甚至略优于α-defensin。
英文摘要:
      Objective To verify the reliability of proteinase 3 (PRTN3) and myeloid nuclear differentiation antigen (MNDA) for diagnosing periprosthetic joint infection (PJI) via ELISA, and to compare with traditional biomarkers α-defensin. Methods A total of 65 consecutive specimens from patients with suspected PJI were included in this study. Based on the 2014 Musculoskeletal Infection Society (MSIS) criteria, 29 patients were included in the PJI group and 36 in the non-PJI group. Commercial ELISA kits were used to detect the biomarker levels in synovial fluid. The sensitivity and specificity of the biomarkers were analyzed, and receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of the investigated biomarkers. Results The PJI group was dominated by staphylococcus, accounting for 31%, and the negative culture patients accounted for 34.5%. PRTN3 had the highest area under the curve at 0.984 (95% CI, 0.961-1.000), followed by α-defensin and MNDA, with AUC of 0.944 (95% CI, 0.888-1.000) and 0.849 (95% CI, 0.755-0.943), respectively. The cutoff value of PRTN3 was 318.000 ng/mL), and its sensitivity and specificity were 0.931 and 0.972, respectively. The cutoff value of α-defensin was 7.150 μg/mL, and its sensitivity and specificity were 0.931 and 0.861, respectively. The cutoff value of MNDA was 4.318 ng/mL, and its sensitivity and specificity were 0.862 and 0.722, respectively. Conclusion Both PRTN3 and MNDA are excellent biomarkers for PJI. The PRTN3 has the best performance even slightly better than that of α-defensin.
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