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

doi:10.3969/j.issn.1006-5725.2024.06.014

Abstract

Abstract:

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

CLC Number:

R738.3

Changzhi GUO,Tao SUN,Shuman HAN,Lingxiang WANG,Mengjing. NIU. Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2[J]. The Journal of Practical Medicine, 2024, 40(6): 814-819.

Figures/Tables 6

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References 27

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影响因素	感染（n = 16）	非感染（n = 120）	t/χ²/Z值	P值
年龄（x ± s，岁）	29.18 ± 3.84	28.14 ± 4.02	0.977	0.330
性别（例）			0.000	0.99
男	10	75
女	6	45
BMI（x ± s，kg/m²）	22.08 ± 7.85	22.33 ± 9.43	0.101	0.919
吸烟史（例）			0.159	0.690
有	6	39
无	10	81
糖尿病（例）			0.236	0.627
有	3	17
无	13	103
肿瘤位置（例）			0.170	0.680
股骨远端（例）	12	84
胫骨近端（例）	4	36
恶性肿瘤分期（例）			0.701	0.402
Ⅱ	11	86
Ⅲ	5	24
术后化疗（例）			9.897	0.002
是	14	47
否	6	63
手术时间（例）			6.663	0.010
≥ 180 min	12	55
< 180 min	4	65
截骨长度（x ± s，cm）	15.95 ± 2.81	14.5 ± 3.59	1.530	0.128
术中出血量（x ± s，mL）	504 ± 101	498 ± 125	0.184	0.854
白细胞（x ± s，×10⁹/L）	2.73 ± 0.96	3.41 ± 1.15	2.260	0.025
中性粒细胞百分比（x ± s，%）	0.44 ± 0.12	0.56 ± 0.23	2.045	0.043
血清D-二聚体［M（P₂₅， P₇₅）， ng/mL］	752（251，1141）	164（101，325）	2.338	0.019
血清TLR2（x ± s，ng/mL）	51.99 ± 11.02	46.01 ± 10.18	2.186	0.031

影响因素	赋值
术后化疗	否 = 0，是 = 1
手术时间	< 180 min=0，≥ 180 min = 1
白细胞	≥ 3 × 10⁹/L = 0，< 3 × 10⁹/L = 1，
中性粒细胞	≥ 0.5% = 0，< 0.5% = 0
血清D-二聚体	< 450 ng/mL = 0，≥ 450 ng/mL = 2
血清TLR2	< 48 ng/mL = 0，≥ 48 ng/mL = 2

变量	β	SE	wald χ²	P值	OR	95%CI
术后化疗	1.145	0.533	4.615	0.032	3.142	1.106 ~ 8.932
手术时间	1.271	0.615	4.271	0.039	3.564	1.068 ~ 11.898
白细胞	1.301	0.585	4.946	0.026	3.673	1.167 ~ 11.561
中性粒细胞	1.424	0.737	3.733	0.053	4.154	0.980 ~ 17.611
血清D-二聚体	1.296	0.502	6.665	0.010	3.655	1.366 ~ 9.776
血清TLR2	1.571	0.734	4.581	0.032	4.811	1.142 ~ 20.280

检验项目	AUC	SE	P值	95%CI	截断值（ng/mL）	灵敏度	特异度	约登指数
TLR2	0.778^a	0.059	< 0.001	0.662 ~ 0.894	51.13	0.708	0.812	0.52
D-二聚体	0.894	0.047	< 0.001	0.801 ~ 0.987	666.67	0.908	0.75	0.658
联合诊断	0.917	0.039	< 0.001	0.841 ~ 0.992	-	0.975	0.75	0.725

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Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2

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