界膜组织细菌16S rRNA和23S rRNA对假体周围感染的诊意义
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摘要
目的对界膜组织中细菌16S rRNA、23S rRNA进行PCR检测,分析比较两者单独以为及联合应用于假体周围感染诊断的效率。方法应用诊断标准对本机构67例髋关节翻修患者是否患有假体周围感染(PJI)作出诊断;用PCR技术检测各界膜组织中细菌16S rRNA和23S rRNA基因片段的表达,同样对PJI作出诊断。分别将16S rRNA、23S rRNA、16S rRNA/23S rRNA(即16S rRNA或23S rRNA检测一项为阳性结果即可)以及16S rRNA+23S rRNA 4种策略的诊断结果与诊断标准的结果比较,分析4种策略的敏感性、特异性、阳性及阴性预测值、准确性的差异。结果应用16S rRNA/23S rRNA诊断的敏感性和阴性预测值均高于16S rRNA+23S rRNA(95.7%vs 52.2%,P<0.01;97.6%vs 79.6%,P=0.01)。4种诊断策略的特异性、阳性预测值以及准确性无显著性差异,单独应用16S rRNA或23S rRNA的诊断效率相当。结论单独应用16S rRNA或23S rRNA进行诊断的效率明显差异,16S rRNA/23S rRNA较16S rRNA+23S rRNA更为敏感,且阴性结果可信度更高。
Objective To explore the value of detecting bacterial 16 S rRNA with 23 S rRNA in the diagnosis of periprosthetic joint infection(PJI). Methods A prospective study was conducted among 67 patients with previous total hip arthroplasty(THA)undergoing a reoperation for infection(23 patients) or aseptic loosening(44 patients). Bacterial 16 S rRNA and 23 S rRNA in the interface membrane were detected by real- time PCR and their value in diagnosis of PJI was assessed. Results The 16 S rRNA and 23 S rRNA showed no significant difference in their power in the diagnosis of PJI. The detection of 16 S rRNA/23 S rRNA showed a higher sensitivity and a greater negative predictive value in PJI diagnosis than the detection of 16 S rRNA+23S rRNA(95.7% vs 52.2%, P<0.01; 97.6% vs 79.6%, P=0.01). The specificity, positive predictive value, and accuracy of the 4 diagnostic strategies were not significantly different. Conclusion The diagnostic power of 16 S rRNA and 23 S rRNA was similar in detecting PJI. Compared with the diagnostic strategy with 16 S rRNA + 23 S rRNA, 16 S rRNA/23 S rRNA is more sensitive in detecting PJI.
Objective To explore the value of detecting bacterial 16 S rRNA with 23 S rRNA in the diagnosis of periprosthetic joint infection(PJI). Methods A prospective study was conducted among 67 patients with previous total hip arthroplasty(THA)undergoing a reoperation for infection(23 patients) or aseptic loosening(44 patients). Bacterial 16 S rRNA and 23 S rRNA in the interface membrane were detected by real- time PCR and their value in diagnosis of PJI was assessed. Results The 16 S rRNA and 23 S rRNA showed no significant difference in their power in the diagnosis of PJI. The detection of 16 S rRNA/23 S rRNA showed a higher sensitivity and a greater negative predictive value in PJI diagnosis than the detection of 16 S rRNA+23S rRNA(95.7% vs 52.2%, P<0.01; 97.6% vs 79.6%, P=0.01). The specificity, positive predictive value, and accuracy of the 4 diagnostic strategies were not significantly different. Conclusion The diagnostic power of 16 S rRNA and 23 S rRNA was similar in detecting PJI. Compared with the diagnostic strategy with 16 S rRNA + 23 S rRNA, 16 S rRNA/23 S rRNA is more sensitive in detecting PJI.
引文
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[20]Sell S,Schleh T.C-reactive protein as an early indicator of the formation of heterotopic ossifications after total hip replacement[J].Arch Orthop Trauma Surg,1999,119(3/4):205-7.
[21]Greidanus NV,Masri BA,Garbuz DS,et al.Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty.A prospective evaluation[J].J Bone Joint Surg Am,2007,89(7):1409-16.
[22]Ghanem E,Antoci V,Pulido L,et al.The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty[J].Int J Infect Dis,2009,13(6):e444-9.
[23]Buttaro MA,Tanoira I,Comba F,et al.Combining C-reactive protein and interleukin-6 May be useful to detect periprosthetic hip infection[J].Clin Orthop Relat Res,2010,468(12):3263-7.
[23]Tohtz SW,Müller M,Morawietz L,et al.Validity of frozen sections for analysis of periprosthetic loosening membranes[J].Clin Orthop Relat Res,2010,468(14):762-8.
[25]Panousis K,Grigoris P,Butcher I,et al.Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92cases[J].Acta Orthop,2005,76(3):341-6.
[26]Mu?oz-Mahamud E,Soriano A,Combalia A,et al.Comparison of bacterial results from conventional cultures of the periprosthetic membrane and the synovial or pseudocapsule during hip revision arthroplasty[J].Arch Orthop Trauma Surg,2014,134(4):577-83.
[27]Bjerkan G,Witso E,Nor A,et al.A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening[J].J Med Microbiol,2012,61(4):572-81.
[2]Krenn V,K?lbel B,Huber M,et al.Revision arthroplasty:Histopathological diagnostics in periprosthetic joint infections[J].Orthopade,2015,44(5):349-56.
[3]Kurtz S,Ong K,Lau E,et al.Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030[J].J Bone Joint Surg Am,2007,89(4):780-5.
[4]Nelson CL,Mclaren AC,Mclaren SG,et al.Is aseptic loosening truly aseptic[J].Clin Orthop Relat Res,2005(437):25-30.
[5]Krenn V,Poremba C,Schneider J,et al.Histopathological differential diagnostics in context of joint implant allergic reactions[J].Orthopade,2013,42(8):614-21.
[6]Chimento GF,Finger S,Barrack RL.Gram stain detection of infection during revision arthroplasty[J].J Bone Joint Surg Br,1996,78(5):838-9.
[7]蔡碰德.界膜16S r RNA、23S r RNA及IL-6诊断假体周围感染的研究[D].长沙:中南大学,2013.
[8]刘天盛,王宇强,王景贵,等.人工关节无菌性松动界膜中的溶骨因子[J].中国组织工程研究与临床康复,2010,14(35):6496-9.
[9]马建兵,刘淼,姚建锋,等.松动的人工髋关节界膜的研究[J].中国矫形外科杂志,2009,17(6):424-7.
[10]Taki N,Tatro JM,Nalepka JL,et al.Polyethylene and Titanium particles induce osteolysis by similar,lymphocyte-independent,mechanisms[J].J Orthop Res,2005,23(2):376-83.
[11]Hanssen AD,Osmon DR,Nelson CL.Prevention of deep periprosthetic joint Infection[J].Instr Course Lect,1997,46(4):555-67.
[12]Hanssen AD,Rand JA.Evaluation and treatment of infection at the site of a total hip or knee arthroplasty[J].Instr Course Lect,1999,48(7):111-22.
[14]Müller M,Morawietz L,Hasart O,et al.Histopathological diagnosis of periprosthetic joint infection following total hip arthroplasty:use of a standardized classification system of the periprosthetic interface membrane[J].Orthopade,2009,38(11):1087-96.
[15]Tunney MM,Dunne N,Einarsson G,et al.Biofilm formation by bacteria isolated from retrieved failed prosthetic hip implants in an in vitro model of hip arthroplasty antibiotic prophylaxis[J].J Orthop Res,2007,25(1):2-10.
[16]Kaufman RL,Tong I,Beardmore TD,et al.Prosthetic synovitis:clinical and histologic characteristics[J].J Rheumatol,1985,12(6):1066-74.
[17]Bori G,Mu?oz-Mahamud E,Garcia S,et al.Interface membrane is the best sample for histological study to diagnose prosthetic joint infection[J].Mod Pathol,2011,24(4):579-84.
[18]Ghanem E,Antoci VJ,Pulido L,et al.The use of receiver operating characteristics analysis in determining erythreeyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetie infection prior to revision total hip arthroplasty[J].Int J Infect Dis,2009,13(6):444-9.
[8]刘诚,张会英.人工髋关节细菌性感染假体松动与实验室数值的相关性分析[J].中国误诊学杂志,2007,7(8):1740-1.
[20]Sell S,Schleh T.C-reactive protein as an early indicator of the formation of heterotopic ossifications after total hip replacement[J].Arch Orthop Trauma Surg,1999,119(3/4):205-7.
[21]Greidanus NV,Masri BA,Garbuz DS,et al.Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty.A prospective evaluation[J].J Bone Joint Surg Am,2007,89(7):1409-16.
[22]Ghanem E,Antoci V,Pulido L,et al.The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty[J].Int J Infect Dis,2009,13(6):e444-9.
[23]Buttaro MA,Tanoira I,Comba F,et al.Combining C-reactive protein and interleukin-6 May be useful to detect periprosthetic hip infection[J].Clin Orthop Relat Res,2010,468(12):3263-7.
[23]Tohtz SW,Müller M,Morawietz L,et al.Validity of frozen sections for analysis of periprosthetic loosening membranes[J].Clin Orthop Relat Res,2010,468(14):762-8.
[25]Panousis K,Grigoris P,Butcher I,et al.Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92cases[J].Acta Orthop,2005,76(3):341-6.
[26]Mu?oz-Mahamud E,Soriano A,Combalia A,et al.Comparison of bacterial results from conventional cultures of the periprosthetic membrane and the synovial or pseudocapsule during hip revision arthroplasty[J].Arch Orthop Trauma Surg,2014,134(4):577-83.
[27]Bjerkan G,Witso E,Nor A,et al.A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening[J].J Med Microbiol,2012,61(4):572-81.