膝关节骨性关节炎关节置换术后切口感染病原菌及血清BMP9、ICAM-1、DPP4水平的预测价值OA

Objective To discuss the pathogen of incision infection after joint replacement surgery for knee osteoarthritis(KOA),and the predictive value of serum bone morphogenetic protein 9(BMP9),intercellular adhesion molecule-1(ICAM-1),and dipeptidyl peptidase 4(DPP4).Methods From January 2022 to January 2025,245 patients with knee osteoarthritis(KOA)who underwent joint replacement surgery in our hospital were enrolled as the research subjects.The incidence of incision pathogen infection in KOA patients 14 days after surgery was statistically analyzed,and they were grouped into the positive infection group(infected with pathogens)of 21 cases and the negative infection group(without pathogen infection)of 224 cases.ELISA method was used to detect serum BMP9,ICAM-1,and DPP4.Multivariate Logistic regression was used to explore the influencing factors of pathogen infection in KOA patients.ROC curve was used to evaluate the predictive value of BMP9,ICAM-1,and DPP4 for KOA pa-tients with positive pathogen infection.Results Totally 37 pathogens were isolated from the incision secretions of 21 KOA patients with postoperative infection.The total number and composition ratio of Gram-positive bacteria(5 categories including Staphylococ-cus aureus)were 21 strains(56.76％),Gram-negative bacteria(4 categories including Escherichia coli)were 14 strains(37.84％),and the total number and composition ratio of fungi were 2 strains(5.40％).The positive infection group had signifi-cantly lower serum BMP9,and significantly higher ICAM-1 and DPP4 than those in the negative infection group(P＜0.05).The positive infection group had significantly higher proportions of surgical time of≥2 hours and preoperative ASA grades 3 and 4 than the negative infection group(P＜0.05).Surgical time,preoperative ASA grading,ICAM-1,DPP4 were risk factors for postoperative incision pathogen infection in KOA patients,while BMP9 was a protective factor(P＜0.05).The combination of BMP9,ICAM-1,and DPP4 had an AUC of 0.934(95％CI 0.896～0.971)in predicting KOA patients with positive pathogen infection,which was superior to the single predictions of BMP9(Z=2.123,P＜0.05),ICAM-1(Z=2.186,P＜0.05),and DPP4(Z=2.561,P＜0.05).Conclusion Serum BMP9 is reduced,and ICAM-1 and DPP4 are increased in KOA patients with positive incision patho-gen infection.The combined prediction of the three factors has high value in predicting KOA patients with positive incision patho-gen infection.