| Clinical value analysis of D-dimer,CRP and ESR in diagnosis of Periprosthetic joint Infection Objective:Periprosthetic joint infection(PJI)is the most common complication after artificial joint replacement,which seriously affects the physical and mental health of patients.PJI or aseptic loosening before revision surgery is very important and has important clinical significance.Through blood D-dimer,CRP and the specific test results of the ESR,effective in the diagnosis of the single index such as using ROC curve and joint inspection in the process of PJI diagnostic sensitivity and specificity,the difference of the D-dimer in clinical PJI diagnosis to provide the reference value analysis and evaluation,to clinical exploration PJI and aseptic loosening of high reference value in the differential diagnosis methods.Methods:Eighty patients who underwent total joint replacement in our hospital from April2017 to August 2018 were included in the study and divided into PJI group according to MSIS criteria(26 cases,14 cases of knee replacement +12 cases of hip replacement).Non-PJI group(54 cases,33 cases of knee arthroplasty +21 cases of hip arthroplasty);Analysis of two groups of patients with postoperative venous D-dimer,ESR and CRP expression level,the ROC the receiver-operating characteristic curve analysis group D-dimer,ESR and CRP in patients with expression level of sensitivity and specificity,determine the various indicators separate testing and the value of combined detection,determine D-dimer in the clinical diagnosis value of as PJI,basis for the following research.Results:1.Clinical baseline data analysis: sex ratio,mean age,BMI and surgery in the two Groups.The difference of index data was small,with P values of0.120,0.089,0.112 and 0.078,respectively,all greater than 0.05.The difference of data was not statistically significant.2.Expression analysis of D-dimer,CRP and ESR concentrations: D-dimer:continuous variable of non-normal distribution of d-dimer detection data of patients,expressed as median(quartile);The D-dimer concentration in the PJI group was significantly higher than that in the non-PJI group,with the median concentration of1953.35ng/ml in the PJI group and 336.50ng/ml in the non-PJI group,and the Z-value of 17.78,P<0.001,indicating statistically significant differences.CRP: the continuous variable of the non-normal distribution of the data of patients' CRP test results,represented by the median(quartile);The CRP concentration of the PJI group was significantly higher than that of the non-PJI group.The median concentration of CRP in the PJI group was 5.61mg/L,while the median concentration of CRP in the non-PJI group was 1.9 mg/L,with a Z value of 13.73 and a P<0.001.The difference was statistically significant.ESR: continuous variable of non-normal distribution of patients' CRP test result data,represented by median(quartile);The concentration of ESR in the PJI group was significantly higher than that in the non-PJI group,and the median concentration of ESR in the PJI group was 40.4mm/h.The median concentration of ESR in non-PJI group was 13.87mm/h.Z=7.89,P<0.001,the difference was statistically significant.3.ROC curve analysis: the sensitivity and specificity of D-dimer at the critical value were 80.77% and 79.63%,respectively.The area value of AUC was 0.890,and within the 95% confidence interval(0.814-0.966),statistical data was analyzed,P<0.001,and the difference was statistically significant.CRP: the sensitivity and specificity of CRP at the critical value were 84.61% and 64.81%,respectively.The area value of AUC was 0.831,and within the 95% confidence interval(0.737~0.926),statistical data were analyzed,P<0.001,and the difference was statistically significant.The sensitivity and specificity of ESR at the critical value were 73.08% and 90.47%,respectively.The area value of AUC was 0.838,and within the 95% confidence interval(0.732~0.944),the statistical data was analyzed,and the difference was statistically significant(P<0.001).4.Analysis of individual and combined test results of each indicator: the accuracy comparison trend of the number of positive test cases in the PJI group was the highest in D-dimer,followed by CRP,and the lowest in ESR.The combined test of the three was significantly higher than any of them,P<0.001,and the difference was statistically significant.The Non-PJI test group showed the same trend,with the highest negative test accuracy of d-dimer,followed by CRP,and the lowest ESR.The combined test of the three was significantly higher than any of them.Data analysis,P<0.001,showed statistically significant differences.Diagnostic value: the AUC area of D-dimer was the largest,followed by CRP and ESR,and the AUC area of D-dimer was the largest,with high sensitivity and specificity.5.Analysis of individual and combined test results of each indicator: the accuracy comparison trend of the number of positive test cases in the PJI group was the highest in D-dimer,followed by CRP,and the lowest in ESR.The combined test of the three was significantly higher than any of them,P<0.001,and the difference was statistically significant.The Non-PJI test group showed the same trend,with the highest negative test accuracy of D-dimer,followed by CRP,and the lowest ESR.The combined test of the three was significantly higher than any of them.Data analysis,P<0.001,showed statistically significant differences.Diagnostic value: the AUC area of D-dimer was the largest,followed by CRP and ESR,and the AUC area of D-dimer was the largest,with high sensitivity and specificity.Conclusions:1.D-dimer has shown high diagnostic value in clinical diagnosis of PJI,which can be compared with CRP and ESR.The value of clinical diagnosis is compared as the basis of infection in the early stage of joint replacement.2.The combined sensitivity and specificity of the three are the highest,which are worthy of clinical recommendation;But to confirm D-dimer the better detection performance of polymer compared with other mature serummarkers still needs to be further verified.Clinical value of D-dimer,CRP and ESR in the diagnosis of Periprosthetic joint Infection in vivo.Objective:The value of D-dimer in the diagnosis of PJI after joint replacement was studied by using the model of prosthesis infection after joint replacement in rabbits,and the diagnostic threshold was defined and compared with other indexes,so as to provide further experimental basis and basis for the clinical application of D-dimer.Methods:Forty-five Japan white rabbits were randomly divided into three groups,and a blank control group was set: the white rabbits did not do any treatment;experimental group A: the model of knee joint replacement was made by white rabbits.experimental group B: knee replacement model + staphylococcus aureus infection in rabbits;Two weeks after the model was prepared,venous blood from the ear region of each group was used for the detection of D-dimer,CRP and ESR.After air embolization,the rabbits of the experimental group A and B were put to death and the samples of joint fluid were extracted through joint cavity puncture.Detection of success rate of the rabbit model: the synovial tissues in the joints of each group were taken for immunohistochemical analysis to determine the degree of inflammation.X-ray analysis of knee joint fixation in each group;After successful establishment of the model,ROC curve analysis of CRP in the joint fluid of the experimental group B of white rabbits was performed to effectively evaluate the diagnostic value of D-dimer as a biomarker for periprosthetic infection after joint replacement.Results:1?Successful verification of joint replacement model: X has been tested and confirmed to have a good joint placement position and screw.The tail end has 1mmprotrusion and joint cavity;X-ray examination 1 and 2 weeks after the surgery showed that the prosthesis was still in the position,and the cartilage around the joint was swollen,but there was no obvious loosening of the prosthesis.Analysis of the general situation: in the control group,the articular cartilage was relatively smooth in the joint cavity,and there was no obvious swelling or inflammatory reaction in the joint capsule and surrounding tissues.In the experimental group A,the articular cavity was relatively smooth,granulation tissue proliferation was observed around the prosthesis,obvious swelling was observed in the ganglion sac and surrounding tissues,synovium was relatively thick,edema was slightly observed,and the degree of inflammation was relatively low.In the experimental group B,the inflammatory state of the rabbits was more obvious.There were more purulent joint exudates in the joint cavity of the rabbits,inflammatory tissue parcels around the prosthesis,and severe swelling of the joint capsule and synovium.In the control group and the experimental group A,there was no significant death,and in the experimental group B,two rabbits died.ELISA test showed that the expression levels of inflammatory factors IL-6 and IL-1 were the highest in the experimental group B,followed by the experimental group A,and finally in the control group.The comparison between the data of each group showed that P<0.05,showing statistically significant differences.2?D-dimer,CRP and ESR concentrations in the venous blood of each group were the highest: D-dimer,CRP and ESR concentrations were the highest in the experimental group B,with median concentrations of 8.35?g/L,2.15mg/L and20.33mm/h,respectively.The D-dimer,CRP and ESR concentrations in the experimental group A were the second highest,and the median concentrations were5.67?g/L,1.58mg/L and 15.64mm/h,respectively.The D-dimer,CRP and ESR concentrations in the control group were the lowest,with median concentrations of3.20? g/L,1.15mg/L and 5.18mm/h,respectively.Comparative analysis of the data showed that P<0.01,the difference was statistically significant.3?Sensitivity and specificity analysis of D-dimer,CRP and ESR in venous blood for diagnosis of PJI: the sensitivity of D-dimer in the diagnosis of PJI was 84.61%(95%CI: 68.90-94.92%)%),and the specificity was 86.67%(95%CI: 65.68-92.37%).In the evaluation of CRP,the sensitivity of CRP in the diagnosis of PJI was 79.62%(95%CI: 68.74-96.77%),and the specificity was 80.00%(95%CI: 53.50-76.88%).The sensitivity of ESR to evaluate PJI was 61.53%(95%CI: 55.98-91.13%),and the specificity was 73.33%(95%CI: 80.99-95.67%).The AUC areas of D-dimer,CRP and ESR in the diagnosis of PJI in venous blood of white rabbits were 0.890,0.812 and 0.798,respectively.4?Analysis of CRP concentration expression in articular fluid of each group:the experimental group B had the highest CRP expression concentration.The median concentration of CRP in the experimental group A was 2.35mg/L,followed by the median concentration of 1.48mg/L in the model group,and the lowest concentration of CRP in the control group,with the median concentration of 0.75 mg/L.Comparative analysis of the data showed that P<0.01,the difference was statistically significant.5?Sensitivity and specificity analysis of D-dimer in blood and CRP in joint fluid for the diagnosis of PJI.The sensitivity of D-dimer in blood in the diagnosis of PJI was 84.61%(95%CI: 68.90-94.92%),the specificity was 86.67%(95%CI:65.68-92.37%),and the AUC area was 0.890(0.811~0.934).In the evaluation of CRP,the sensitivity of CRP in the diagnosis of PJI was 84.61%(95%CI:70.58-97.89%),the specificity was 80.00%(95%CI:53.50-76.88%),and the AUC area was 0.856(0.809~0.923).6.ROC curve analysis of CRP concentration expression in articular fluid of animals in each group: CRP was measured at the critical value.The corresponding sensitivity and specificity were 84.61% and 80.00%,respectively,and the area value of AUC was 0.856,within the 95% confidence interval(0.809~0.923).Statistical data analysis showed that the difference was statistically significant(P<0.001).7?Effect analysis of separate and combined detection of each diagnostic indicator: in the separate analysis of each diagnostic indicator.The sensitivity,specificity and AUC area of d-dimer were better than that of CRP and ESR.Thesensitivity of blood d-dimer was the same as that of CRP in joint fluid,and the specificity and AUC area were higher than that of CRP in joint fluid.Conclusions:1.In the white rabbit joint replacement model,the prosthesis position was fixed well two weeks after X-ray examination in the experimental group A and B.In the experimental group B,the inflammatory response increased,abscess appeared in the articular cavity of the infection group,and the expression levels of IL-6 and IL-1increased,suggesting the success of the joint replacement model and PJI model in the white rabbit.2.The highest d-dimer,CRP and ESR concentrations were found in the venous blood of rabbits in the experimental group B.The experimental group A was followed by the control group.Compared with CRP and ESR,blood D-dimer showed the highest sensitivity,specificity and AUC area in diagnosing PJI.The sensitivity,specificity and AUC area of the combined diagnosis of PJI were the highest,which was consistent with the clinical conclusion.3.Compared with CRP in joint fluid,blood D-dimer has the same sensitivity,specificity and AUC in diagnosis of PJI.Higher area;In summary,it can be seen that hemorrhage-dimer has a high clinical value in the diagnosis of PJI,which is worth further clinical exploration. |
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