假体周围感染诊断新进展

doi:10.3877/cma.j.issn.1674-134X.2018.01.017

假体周围感染(PJI)是关节置换术后一种严重的并发症，虽然该病的诊断方法多种，但目前尚无"金标准"，同时由于目前使用的部分诊断手段灵敏度与特异度较低，导致结果的解读较模糊。近年来发现的一些较新的诊断技术，如白细胞酯酶检测，α－防御素为代表的关节液生物标记物，具有极高的敏感性与特异性，但目前尚未在国内推广。还有很多学者与临床医生在研究超声裂解及多聚酶链反应(PCR)技术来提高细菌培养阳性率，但这些方法操作复杂，可行性低，因此需进一步研究更加简便、准确、稳定且应用性强的检查手段。

关键词: 关节成形术, 手术后并发症, 假体相关感染, 诊断

Periprosthetic joint infection(PJI)is a devastating complication after total joint arthroplasty.Although there are many diagnostic methods for this disease, there is no "golden standard" for the diagnosis of PJI. Because of the low sensitivity and specificity of some diagnostic tools, as a result, the interpretation of the results are obscure. In recent years, a number of new diagnostic techniques, such as leukocyte esterase assays and α-defensins have been identified as representative factors of the joint fluid biomarkers, with high sensitivity and specificity, but it has not been popularized in China yet. With the development of technology, there are many scholars and clinicians studying ultrasound lysis and polymerase chain reaction technology to improve the positive rate of culture. But these methods are complicated and low feasibility, more researches are needed for more simple, accurate, stable and practical methods.

Key words: Arthroplasty, Postoperative complications, Infections, prosthesis-related, Diagnosis

表1 2014年假体周围感染国际共识与2015年英国CDC的髋与膝关节置换术后假体周围感染的概念

?	PJI概念
国际共识(2014年)^[1]	需满足下列三项中至少一项
	主要标准：
	1．存在与假体相通的窦道
	2．两次从假体取下来的标本培养为同一细菌
	次要标准：
	3．下列5项中满足3项：
	a．红细胞沉降率与C反应蛋白升高。
	b．关节液白细胞计数升高或白细胞酯酶(LE)试纸呈＋＋。
	c．关节液中性粒细胞比例升高。
	d．单次培养阳性。
	e．假体周围组织病理学分析结果阳性。
英国CDC(2015年)^[2] *只对髋关节与膝关节	?
	需满足下列三项中至少一项
	主要标准：
	1．存在与假体相通的窦道
	2．两次关节液或组织培养为同一细菌
	次要标准：
	3．下列5项中满足3项：
	a．CRP>100 mg/L并ESR>30 mm/h
	b．关节液WBC>10 000个/μl或白细胞酯酶试纸呈＋＋。
	c．关节液中性粒细胞比例升高(>90%)。
	d．单次从假体取的标本或关节液培养阳性。
	e．假体周围组织病理学分析结果阳性(每个高倍视野中性粒细胞>5个)

表1 2014年假体周围感染国际共识与2015年英国CDC的髋与膝关节置换术后假体周围感染的概念

?	PJI概念
国际共识(2014年)^[1]	需满足下列三项中至少一项
	主要标准：
	1．存在与假体相通的窦道
	2．两次从假体取下来的标本培养为同一细菌
	次要标准：
	3．下列5项中满足3项：
	a．红细胞沉降率与C反应蛋白升高。
	b．关节液白细胞计数升高或白细胞酯酶(LE)试纸呈＋＋。
	c．关节液中性粒细胞比例升高。
	d．单次培养阳性。
	e．假体周围组织病理学分析结果阳性。
英国CDC(2015年)^[2] *只对髋关节与膝关节	?
	需满足下列三项中至少一项
	主要标准：
	1．存在与假体相通的窦道
	2．两次关节液或组织培养为同一细菌
	次要标准：
	3．下列5项中满足3项：
	a．CRP>100 mg/L并ESR>30 mm/h
	b．关节液WBC>10 000个/μl或白细胞酯酶试纸呈＋＋。
	c．关节液中性粒细胞比例升高(>90%)。
	d．单次从假体取的标本或关节液培养阳性。
	e．假体周围组织病理学分析结果阳性(每个高倍视野中性粒细胞>5个)

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