Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2
Received date: 2023-07-26
Online published: 2024-04-08
目的 通过对膝关节肿瘤型假体周围感染（prosthetic joint infection， PJI）进行影响因素分析，以及D-二聚体、Toll样受体2（TLR2）的诊断价值分析，为PJI的早期识别和诊断提供依据。 方法 选取2008年1月至2020年6月在我科室治疗并行随访的患者，根据纳入排除标准选取136例观察对象后收集其资料，包括其年龄、性别、BMI、糖尿病史、吸烟史、肿瘤位置、恶性肿瘤分期、手术时间、截骨长度、术中出血量、术后第3天中性粒细胞百分比、白细胞、血清D-二聚体、血清TLR值；分析PJI发生的危险因素及血清D-二聚体、血清TLR的诊断价值。 结果 PJI的发生率为11.76%；术后化疗、手术时间≥ 180 min为PJI发生的危险因素（P < 0.05）；两指标联合、血清D-二聚体、血清TLR2的曲线下面积（area under curve， AUC）依次为0.917、0.894、0.778， TLR2的AUC小于两指标联合诊断（P < 0.05）；灵敏度依次为0.975、0.908、0.708，特异度依次为0.750、0.750、0.812。 结论 术后化疗、手术时间≥ 180 min为PJI发生的危险因素；两指标联合预测价值较高。
郭昶志 , 孙涛 , 韩殊曼 , 王令响 , 牛梦婧 . 膝关节肿瘤假体发生周围感染的危险因素分析及血清D-二聚体、Toll样受体2的预测价值[J]. 实用医学杂志, 2024 , 40(6) : 814 -819 . DOI: 10.3969/j.issn.1006-5725.2024.06.014
Objective To investigate the influencing factors of peripheral infections of knee joint tumor prosthesis as well as the value of serum D-D and TLR2 in predicting the infection risks so as to provide a reference for early diagnosis of tumorous periprosthetic infection （PJI） of knee joint. Methods The patients who were treated and followed up in our department from January 2008 to June 2020 were selected. According to the inclusion and exclusion criteria， 136 of the patients were selected. The data including age， gender， BMI， history of diabetes， smoking history， tumor location， stage of malignant tumor， operation time， osteotomy length， intraoperative bleeding， and the percentage of neutrophils， leukocytes， serum D-dimer， and serum TLR value 3 days after operation were collected. The risk factors of PJI and the diagnostic value of serum D-dimer and serum TLR were analyzed. Results The incidence of PJI was 11.76%. Postoperative chemotherapy and operation time ≥ 180 min were the risk factors of PJI （P < 0.05）. The area under curve （AUC） of the combination of two indicators， serum D-dimer and serum TLR2 were 0.917， 0.894 and 0.778， respectively. The AUC of TLR2 was lower than that of the combination of two indicators （P < 0.05）； The sensitivity was 0.975， 0.908 and 0.708， respectively， and the specificity was 0.75， 0.75， and 0.812， respectively. Conclusion Postoperative chemotherapy and operation time ≥ 180 min are the risk factors of PJI. The combination of D-dimer and TLR2 has good diagnostic value.
Key words： periprosthetic infection; knee joint; risk factors; D-dimer; TLR2
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