【摘要】 目的 评估二代测序技术在假体周围感染病原菌诊断中的实用性和有效性。方法 选择2019年8月-2022年1月在我院骨科就诊且接受人工关节翻修手术患者46例，根据2018年国际共识会议（ICM）诊断标准分为无菌性松动组（21例）和假体周围感染组（25例）。比较术前血清白细胞（WBC）、C反应蛋白（CRP）、红细胞沉降率（ESR）和D二聚体，关节液白细胞计数（关节液WBC），关节液多核细胞计数（关节液PMN）；术中滑膜组织标本同时进行14 d传统细菌培养与二代测序，评价细菌培养、二代测序、细菌培养与二代测序联合诊断的诊断效能。结果 假体周围感染组WBC、CRP、ESR、Synovial WBC、Synovial PMN均高于无菌性松动组，差异有统计学意义（P<0.05）;WBC、CRP、ESR、D-二聚体、关节液WBC和关节液PMN、细菌培养、二代测序、细菌培养与二代测序联合诊断的曲线下面积（AUC）分别为0.717、0.897、0.830、0.769、0.912、0.872、0.740、0.829和0.849。细菌培养与二代测序联合诊断效能优于二代测序，优于传统细菌培养，敏感性、准确度较高，假阴性率较低，但假阳性率较高。结论 二代测序技术作为一种新型诊断工具，较传统细菌培养更高的敏感性、准确度，为假体周围感染病原学诊断提供有力帮助。更多还原

【Abstract】 Objective To evaluate the practicability and effectiveness of second-generation sequencing in the diagnosis of pathogens in periprosthetic infection.Methods From August 2019 to January 2022, 46 patients who underwent artificial joint revision surgery in the Department of Orthopaedics of our hospital were selected. According to the diagnostic criteria of the International Consensus Meeting(ICM)in 2018, they were divided into aseptic loosening group(21 cases)and periprosthetic infection group(25 cases). Preoperative serum white blood cell(WBC), C-reactive protein(CRP),erythrocyte sedimentation rate(ESR)and D-dimer, white blood cell count(WBC)and polynuclear cell count(PMN)in synovial fluid were compared.The synovial tissue samples were simultaneously subjected to 14 days of traditional bacterial culture and second-generation sequencing to evaluate the diagnostic efficacy of bacterial culture, second-generation sequencing, and combined diagnosis of bacterial culture and second-generation sequencing.Results WBC, CRP, ESR, Synovial WBC and Synovial PMN in the periprosthetic infection group were higher than those in the aseptic loosening group(P<0.05). The area under the curve(AUC)of WBC, CRP, ESR, D-dimer, joint fluid WBC and joint fluid PMN, bacterial culture, secondgeneration sequencing, bacterial culture combined with second-generation sequencing were 0.717, 0.897, 0.830, 0.769, 0.912, 0.872, 0.740, 0.829and 0.849, respectively. The diagnostic efficiency of bacterial culture combined with second-generation sequencing was better than that of secondgeneration sequencing, and better than that of traditional bacterial culture. The sensitivity and accuracy were higher, the false negative rate was lower,but the false positive rate was higher.Conclusion As a new diagnostic tool, the second generation sequencing technology has higher sensitivity and accuracy than traditional bacterial culture, which provides a powerful help for the etiological diagnosis of periprosthetic infection.更多还原