BACKGROUND Synovial fluid proteins had been applied as diagnostic biomarkers for periprosthetic joint infection (PJI) in recent research papers. Thus, this meta-analysis aimed to estimate the diagnostic efficiency of synovial fluid α-defensin and leukocyte esterase (LE) for PJI. METHODS We conducted our systematic review by searching the keywords in online databases such as PubMed, Embase, Cochrane, Elsevier, Springer, and Web of Science from the time of database inception to October 2018. Inclusion criteria were as follows: patients who have undergone knee, hip, or shoulder joint replacements; α-defensin or leukocyte esterase (LE strip) of synovial fluid was detected as the biomarker for PJI diagnosis; and Musculoskeletal Infection Society (MSIS) or utilizing a combination of clinical data was considered as the gold standard. Diagnostic parameters including sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary of receiver operating characteristics curve (AUSROC) were calculated for the included studies to evaluate the synovial fluid α-defensin and LE for PJI diagnosis. RESULTS After full-text review, 28 studies were qualified for this systematic review, 16 studies used α-defensin and the other 12 were conducted using LE strip. The pooled sensitivity, specificity, and DOR of LE strip were 87% (95% CI 84-90%), 96% (95% CI 95-97%), and 170.09 (95% CI 97.63-296.32), respectively, while the pooled sensitivity, specificity, and DOR of α-defensin were 87% (95% CI 83-90%), 97% (95% CI 96-98%), and 158.18 (95% CI 74.26-336.91), respectively. The AUSROC for LE strip and α-defensin were 0.9818 and 0.9685, respectively. CONCLUSION Both LE strip and α-defensin of synovial fluid provide rapid and convenient diagnosis for PJI. Sensitivity of α-defensin and LE strip are the same, while both these two methods have high specificity in clinical practice.

中文翻译：

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滑液α-防御素和白细胞酯酶在假体周围关节感染（PJI）诊断中的可靠性：系统评价和荟萃分析。

背景技术在最近的研究论文中，滑膜液蛋白已被用作假体周围关节感染（PJI）的诊断生物标志物。因此，本荟萃分析旨在评估滑液α-防御素和白细胞酯酶（LE）对PJI的诊断效率。方法从数据库建立之日至2018年10月，我们通过在在线数据库（例如PubMed，Embase，Cochrane，Elsevier，Springer和Web of Science）中搜索关键词来进行系统的审查。纳入标准如下：曾患过膝盖的患者，髋关节或肩关节置换；滑液中的α-防御素或白细胞酯酶（LE试纸）被检测为PJI诊断的生物标志物；和肌肉骨骼感染协会（MSIS）或结合临床数据的使用被认为是金标准。计算了包括敏感性，特异性，诊断比值比（DOR）和接收器工作特征曲线摘要下的面积（AUSROC）在内的诊断参数，以评估滑液α-防御素和LE对PJI诊断的意义。结果全文审查后，有28篇研究符合该系统评价的要求，其中16篇使用α-防御素的研究，另12篇使用LE试纸进行。LE条带的合并敏感性，特异性和DOR分别为87％（95％CI 84-90％），96％（95％CI 95-97％）和170.09（95％CI 97.63-296.32）。 α-防御素的合并敏感性，特异性和DOR分别为87％（95％CI 83-90％），97％（95％CI 96-98％）和158.18（95％CI 74.26-336.91）。LE条和α-防御素的AUSROC分别为0.9818和0.9685。结论滑液的LE条带和α-防御素均可为PJI提供快速，便捷的诊断。α-防御素和LE试纸的敏感性相同，而这两种方法在临床实践中具有很高的特异性。