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成人脓毒性关节炎

Authors
Don L Goldenberg, MD
Daniel J Sexton, MD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH
Translators
颜廷宾, 副主任医师

引言

脓毒性关节炎这一术语通常是指关节内的细菌感染，但也包括真菌和分枝杆菌感染。细菌性病原体引起的脓毒性关节炎常以危险且具破坏性的急性关节炎的形式表现。非淋球菌性细菌性关节炎的易感因素、病理生理学、临床表现、诊断和治疗将总结在此。人工关节感染、淋球菌性关节炎以及真菌和分枝杆菌性关节炎因为其临床表现特殊将单独讨论。 (参见“人工关节感染的临床表现和诊断”和“人工关节感染的治疗”和“播散性淋球菌感染”和“骨结核病”)

患病率

在表现为一个或数个关节剧烈疼痛的成人中，细菌性关节炎的患病率约为8%-27%，其中较低的数值(8%)源自一项对就诊于一个市区医院急诊科的100例连续病例的系列研究，而后一个数值(27%)源自一项纳入75例在台湾紧急就诊患者的研究[1,2]。这些病例系列研究纳入了一些人工关节置换术后的患者和少部分最终被诊断为淋球菌性脓毒性关节炎的患者。

易感因素

2007年一项总共纳入6242例出现剧烈关节疼痛患者的系统评价确定了成人脓毒性关节炎的易感因素[3]；其中653例(10%)患有脓毒性关节炎。易感因素及其预测价值[通过估算的阳性似然比(positive likelihood ratio, +LR)反映]总结如下[3,4]：

  • 年龄大于80岁
  • 糖尿病
  • 类风湿关节炎
  • 人工关节
  • 近期接受过关节手术
  • 皮肤感染、皮肤溃疡
  • 静脉吸毒、酗酒
  • 既往关节内糖皮质激素注射史

虽然上述易感因素单独作用时对脓毒性关节炎的患病风险的影响有限，但是，当这些独立危险因素组合时将使患病风险显著增加。例如，有人工关节的患者出现急性关节痛并且同时有皮肤感染的证据时，相关的+LR为15(95%CI 8.1-28)[3]。 (参见“常用生物统计学和流行病学术语词汇表”，关于‘似然比’一节)

                     

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-17.
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