CORR：滑膜液CRP水平诊断假体周围感染参考意义不大

2015-01-29 赵行琪丁香园

假体周围关节感染(Periprosthetic joint infections PJIs)对患者来说是灾难性的，治疗困难，花费昂贵。尽管对于PJI的诊断有公认的指南，但术前区分是PJI还是假体无菌性松动依然是个难题，主要是由于常规检查的诊出率较低所致。常规检查包括滑膜液细胞计数和C-反应蛋白（CRP）分析，若是术前排除了PJI诊断，紧接着要改变手术计划。在现在研究较为火热的分子生物学

假体周围关节感染(Periprosthetic joint infections PJIs)对患者来说是灾难性的，治疗困难，花费昂贵。尽管对于PJI的诊断有公认的指南，但术前区分是PJI还是假体无菌性松动依然是个难题，主要是由于常规检查的诊出率较低所致。

常规检查包括滑膜液细胞计数和C-反应蛋白（CRP）分析，若是术前排除了PJI诊断，紧接着要改变手术计划。在现在研究较为火热的分子生物学和免疫学检测方法中，滑膜液CRP对PJI的诊断具有较为广阔的前景。CRP是机体受到微生物入侵或组织损伤等炎症性刺激时肝细胞合成的急性相非特异性蛋白，当发生PJI时，CRP可通过血运进入滑膜液中。

以往对于滑膜液CRP诊断PJI的研究受限于病例量太小，由于采用的免疫测定方法不同，报导的敏感性也是千差万别的。Tetreault 博士及团队基于前人研究，进行了一项119例因各类原因进行髋或膝关节置换术后行翻修手术的前瞻性观察研究。

使用同样的临床方法和设备对PJI进行诊断，以肌肉骨骼感染学会(Musculoskeletal Infection Society MSIS)的指南作为诊断的金标准（去除血清CRP诊断项），对血清CRP和滑膜液CRP的诊断效能进行比较。

研究人员发现了血清CRP和滑膜液CRP有密切的相关性。由于全身其他炎症反应同样可使得血清CRP升高，这就导致了滑膜液CRP诊断PJI的特异性低。血清CRP的阴性预测效能要高于滑膜液CRP，分别为99%和95%，但这一差异并无统计学意义。

另外，有近15%的滑膜液样本因粘度过高或发生溶血从而不能进行CRP检测。Tetreault等人所报导的结果应该是滑膜液CRP对于PJI诊断的明确研究。血清CRP的检测在临床上广为使用，与之相比，滑膜液CRP的应用较为局限，并且不能提供更多的诊断信息，因此需要做更多的研究来寻找诊断PJI更为敏感和特异的指标。

原始出处：

Cummins NW1.CORR Insights: Is synovial C-reactive protein a useful marker for periprosthetic joint infection? Clin Orthop Relat Res. 2014 Dec;472(12):4004-5. doi: 10.1007/s11999-014-3882-5. Epub 2014 Aug 19.

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2015-06-29 zhangph

#CRP水平#

68 0
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2015-04-12 x35042875

患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

171 0
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2015-04-12 x35042875

患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

165 0
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2015-02-19 orthoW

?学习了

134 0
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2015-02-15 chinayinhan

阳性特异性不高。

125 0
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2015-01-31 rebeccajiejie

#CRP#

76 0
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2015-01-31 lanyan20020088

#假体#

58 0
[GetPortalCommentsPageByObjectIdResponse(id=1783837, encodeId=44091e838378c, content=<a href='/topic/show?id=4e91528168' target=_blank style='color:#2F92EE;'>#CRP水平#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5281, encryptionId=4e91528168, topicName=CRP水平)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Mon Jun 29 15:10:00 CST 2015, time=2015-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20909, encodeId=2222209098f, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=171, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:46:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20910, encodeId=a99120910fe, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:46:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16504, encodeId=c032165042a, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:29:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15527, encodeId=88b21552e7a, content=阳性特异性不高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Sun Feb 15 20:30:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269575, encodeId=0b0b12695e5b1, content=<a href='/topic/show?id=ca6952e52f' target=_blank style='color:#2F92EE;'>#CRP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5275, encryptionId=ca6952e52f, topicName=CRP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1cc90, createdName=rebeccajiejie, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468312, encodeId=c5491468312f4, content=<a href='/topic/show?id=2d3d2e5176a' target=_blank style='color:#2F92EE;'>#假体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27517, encryptionId=2d3d2e5176a, topicName=假体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b576903125, createdName=lanyan20020088, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590682, encodeId=4b5715906821d, content=<a href='/topic/show?id=e31d134e83e' target=_blank style='color:#2F92EE;'>#ORR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13478, encryptionId=e31d134e83e, topicName=ORR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a7b17846501, createdName=psybestwish, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14829, encodeId=305e1482998, content=CRP敏感性不够?, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=223.104.5.**, createdTime=Thu Jan 29 20:05:00 CST 2015, time=2015-01-29, status=1, ipAttribution=)]
2015-01-31 psybestwish

#ORR#

58 0
[GetPortalCommentsPageByObjectIdResponse(id=1783837, encodeId=44091e838378c, content=<a href='/topic/show?id=4e91528168' target=_blank style='color:#2F92EE;'>#CRP水平#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5281, encryptionId=4e91528168, topicName=CRP水平)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6976269, createdName=zhangph, createdTime=Mon Jun 29 15:10:00 CST 2015, time=2015-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20909, encodeId=2222209098f, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=171, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:46:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=20910, encodeId=a99120910fe, content=患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施, beContent=null, objectType=article, channel=null, level=null, likeNumber=165, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:46:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16504, encodeId=c032165042a, content=?学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=134, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:29:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15527, encodeId=88b21552e7a, content=阳性特异性不高。, beContent=null, objectType=article, channel=null, level=null, likeNumber=125, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=da6b7222, createdName=chinayinhan, createdTime=Sun Feb 15 20:30:00 CST 2015, time=2015-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269575, encodeId=0b0b12695e5b1, content=<a href='/topic/show?id=ca6952e52f' target=_blank style='color:#2F92EE;'>#CRP#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5275, encryptionId=ca6952e52f, topicName=CRP)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e1cc90, createdName=rebeccajiejie, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1468312, encodeId=c5491468312f4, content=<a href='/topic/show?id=2d3d2e5176a' target=_blank style='color:#2F92EE;'>#假体#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=27517, encryptionId=2d3d2e5176a, topicName=假体)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b576903125, createdName=lanyan20020088, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1590682, encodeId=4b5715906821d, content=<a href='/topic/show?id=e31d134e83e' target=_blank style='color:#2F92EE;'>#ORR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13478, encryptionId=e31d134e83e, topicName=ORR)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8a7b17846501, createdName=psybestwish, createdTime=Sat Jan 31 02:10:00 CST 2015, time=2015-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14829, encodeId=305e1482998, content=CRP敏感性不够?, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=223.104.5.**, createdTime=Thu Jan 29 20:05:00 CST 2015, time=2015-01-29, status=1, ipAttribution=)]
2015-01-29 223.104.5.**

CRP敏感性不够?

116 0

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CORR：滑膜液CRP水平诊断假体周围感染参考意义不大

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