关节液中细菌16srRNA与23s rRNA诊断膝关节置换术后感染的价值
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摘要
目的探讨利用关节液中细菌16s rRNA与23s rRNA诊断全膝关节置换术后感染的效率及两种基因诊断方法的差异。方法对33例无菌性松动及19例假体周围感染行人工膝关节翻修的患者,通过RT-PCR检测关节液中细菌16s rRNA、23s rRNA保守基因片段诊断假体周围感染。比较两种诊断策略的敏感性、特异性、阳性预测值、阴性预测值及准确性。结果以国外关于假体周围感染诊断方法的文献判定假体周围感染,利用16s rRNA进行诊断的敏感性78.8%,特异性93.9%,阳性预测值88.2%,阴性预测值为88.6%,准确性为88.5%;而采用23s rRNA扩增方法诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为68.4%、78.8%、65.0%、81.2%和75.0%。两种基因诊断的各指标比较差异均无统计学意义(P>0.05)。结论通过检测关节液中细菌16s rRNA或23s rRNA诊断人工膝关节置换术后感染,具有较高的诊断效率,且两者差异无统计学意义。
Objective To explore the power of detecting bacteria 16 s rRNA and 23 srRNA to diagnose periprosthetic joint infection(PJI)after total knee arthroplasty(TKA).Methods A prospective study of 52 patients who had a TKA and were undergoing a reoperation because of infection(19patients)or aseptic loosening(33patients)was conducted.The 16 S rRNA and 23 S rRNA in joint fluid were detected by RT-PCR as a marker to diagnose PJI.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were compared.Results The diagnose power of 16 srRNA was higher than 23s rRNA:sensitivity(78.8% vs 68.4%),specificity(93.9% vs 78.8%),positive predictive value(88.2% vs65.0%),negative predictive value(88.6% vs 81.2%)and accuracy(88.5% vs 75.0%).However,all of those difference was not statistically significant(P>0.05).Conclusion Both 16 srRNA and 23 srRNA have satisfactory diagnosis power of to detect PJI,and there was no difference.
Objective To explore the power of detecting bacteria 16 s rRNA and 23 srRNA to diagnose periprosthetic joint infection(PJI)after total knee arthroplasty(TKA).Methods A prospective study of 52 patients who had a TKA and were undergoing a reoperation because of infection(19patients)or aseptic loosening(33patients)was conducted.The 16 S rRNA and 23 S rRNA in joint fluid were detected by RT-PCR as a marker to diagnose PJI.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were compared.Results The diagnose power of 16 srRNA was higher than 23s rRNA:sensitivity(78.8% vs 68.4%),specificity(93.9% vs 78.8%),positive predictive value(88.2% vs65.0%),negative predictive value(88.6% vs 81.2%)and accuracy(88.5% vs 75.0%).However,all of those difference was not statistically significant(P>0.05).Conclusion Both 16 srRNA and 23 srRNA have satisfactory diagnosis power of to detect PJI,and there was no difference.
引文
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[16]Chakravorty S,Helb D,Burday M,et al.A detailed analysis of 16Sribosomal RNA gene segments for the diagnosis of pathogenic bacteria[J].Microbiol Methods,2007,69(2):330-339.
[17]Kobayashi N,Inaba Y,Choe H,et al.Rapid and sensitive detection of methicillin-resistant Staphylococcus periprosthetic infections using real-time polymerase chain reaction[J].Diagn Microbiol Infect Dis,2009,64(2):172-176.
[18]Trampuz A,Piper K E,Jacobson M J,et al.Sonication of removed hip and knee prostheses for diagnosis of infection[J].N Engl J Med,2007,357(7):654-663.
[19]Rak M,KavˇcIˇc M,Treb2e R,et al.Detection of bacteria with molecular methods in prosthetic joint infection:sonication fluid better than periprosthetic tissue[J].Acta Orthop,2016,87(4):339-345.
[20]Lonner J H,Siliski J M,Della Valle C,et al.Role of knee aspiration after resection of the infected total knee arthroplasty[J].Orthop,2001,30(4):305-309.
[2]Mortazavi S M,Molligan J,Austin M S,et al.Failure following revision total knee arthroplasty:infection is the major cause[J].Int Orthop,2011,35(8):1157-1164.
[3]Bereza P,Ekiel A,Auguciak-Duma A,et al.Comparison of cultures and 16SrRNA sequencing for identification of bacteria in two-stage revision arthroplasties:preliminary report[J].BMC Musculoskelet Disord,2016,25(17):138-142.
[4]Achermann Y,Vogt M,Leunig M,et al.Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants[J].J Clin Microbiol,2010,48(4):1208-1214.
[5]Bauer T W,Parvizi J,Kobayashi N,et al.Diagnosis of periprosthetic infection[J].J Bone Joint Surg Am,2006,88(4):869-882.
[6]Parvizi J,Adeli B,Zmistowski B,et al.Management of periprosthetic joint infection:the current knowledge:AAOS exhibit selection[J].J Bone Joint Surg Am,2012,94(14):e104-e110.
[7]Di Cesare P E,Chang E,Preston C F,et al.Serum interleukin-6as a marker of periprosthetic infection following total hip and knee arthroplasty[J].J Bone Joint Surg Am,2005,87(9):1921-1927.
[8]Honsawek S,Deepaisarnsakul B,Tanavalee A,et al.Relationship of serum IL-6,C-reactive protein,erythrocyte sedimentation rate,and knee skin temperature after total knee arthroplasty:aprospective study[J].Int Orthop,2011,35(1):31-35.
[9]Stroh D A,Johnson A J,Naziri Q,et al.How do frozen and permanent histopathologic diagnoses compare for staged revision after periprosthetic hip infections?[J].J Arthroplasty,2012,27(9):1663-1668.
[10]Banit D M,Kaufer H,Hartford J M.Intraoperative frozen section analysis in revision total joint arthroplasty[J].Clin Orthop Relat Res,2002,(401):230-238.
[11]Nickinson R S,Board T N,Gambhir A K,et al.The microbiology of the infected knee arthroplasty[J].Int Orthop,2010,34(4):505-510.
[12]Stefánsdóttir A,Johansson D,Knutson K,et al.Microbiology of the infected knee arthroplasty:report from the Swedish Knee Arthroplasty Register on 426surgically revised cases[J].Scand J Infect Dis,2009,41(11-12):831-840.
[13]Birmingham P,Helm J M,Manner P A,et al.Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription[J].Journal of Bone and Joint Surgery,2008,90(3):602-608.
[14]Sheridan G E,Masters C I,Shallcross J A,et al.Detection of mRNA by reverse transcription-PCR as an indicator of viability in Escherichia coli cells[J].Appl Environ Microbiol,1998,64(4):1313-1318.
[15]Aellen S,Que Y A,Guignard B,et al.Detection of live and antibiotic-killed bacteria by quantitative real-time PCR of specific fragments of rRNA[J].Antimicrob Agents Chemother,2006,50(6):1913-1920.
[16]Chakravorty S,Helb D,Burday M,et al.A detailed analysis of 16Sribosomal RNA gene segments for the diagnosis of pathogenic bacteria[J].Microbiol Methods,2007,69(2):330-339.
[17]Kobayashi N,Inaba Y,Choe H,et al.Rapid and sensitive detection of methicillin-resistant Staphylococcus periprosthetic infections using real-time polymerase chain reaction[J].Diagn Microbiol Infect Dis,2009,64(2):172-176.
[18]Trampuz A,Piper K E,Jacobson M J,et al.Sonication of removed hip and knee prostheses for diagnosis of infection[J].N Engl J Med,2007,357(7):654-663.
[19]Rak M,KavˇcIˇc M,Treb2e R,et al.Detection of bacteria with molecular methods in prosthetic joint infection:sonication fluid better than periprosthetic tissue[J].Acta Orthop,2016,87(4):339-345.
[20]Lonner J H,Siliski J M,Della Valle C,et al.Role of knee aspiration after resection of the infected total knee arthroplasty[J].Orthop,2001,30(4):305-309.