화농성 관절염과 비화농성 관절염을 구별하기 위한 지표로서의 관절액 Calprotectin: 예비 연구
Synovial Calprotectin as a Biomarker for Distinguishing Septic Arthritis from Non-Septic Arthritis: A Preliminary Study
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배경: Calprotectin은 백혈구에서 분비되는 단백으로 다양한 염증성 질환에서 염증 정도를 확인하는 지표로 이용되고 있다. 이 연구에서는 관절액과 혈청에서의 calprotectin이 화농성 및 비화농성관절염을 구별하는 지표로 이용될 수 있는지 확인하였다. 방법: 2024년 2월부터 4월까지 화농성 관절염이 의심되는 20명 환자의 관절액과 혈청에 대하여 calprotectin 검사를 시행하였다. 대상자들을 화농성 관절염군과 비화농성 관절염군으로 나누어 관절액과 혈청에서의 calprotectin값을 서로 비교하였다. 결과: 화농성 관절염군은 6명(30%)이었다. 화농성 관절염군의 관절액 calprotectin값은 비화농성 관절염군보다 유의하게 높았다(15,291.5 mg/L vs. 6,465.5 mg/L, P<0.001). 화농성 관절염을 진단하는 관절액 calprotectin의 area under the curve (AUC)값은 0.881 이었다(민감도 100%, 특이도 78.6%, 양성예측도 66.7%, 음성예측도 100%). 결론: 관절액에서 측정한 calprotectin은 화농성 관절염과 비화농성 관절염을 구별하는 신뢰할 만한 진단 지표로서 임상적 유용성이 높다.
Abstract
Background: Delayed septic arthritis treatment exacerbates cartilage degradation and causes persistent functional impairments. Hence, the treatment timing profoundly affects the prognosis, although diagnosing specific cases may prove challenging. This study aimed to investigate whether calprotectin can be used as a biomarker to differentiate between septic and non-septic arthritis. Methods: Twenty patients with suspected septic arthritis between February and April 2024 were included in this prospective study. The calprotectin levels in the synovial fluid and serum were measured and compared between the patients with septic and non-septic arthritis. Receiver operating characteristic (ROC) curve analyses were performed to differentiate between the two groups. Results: Synovial fluid calprotectin levels were significantly higher in the septic arthritis group than in the non-septic arthritis group (15,291.5 vs. 6,465.5 mg/L, P <0.001). The area under the ROC curve for synovial fluid calprotectin level in detecting septic arthritis was 0.881 (sensitivity 100%, specificity 78.6%, positive predictive value 66.7%, and negative predictive value 100%). Conclusions: Synovial calprotectin level is a reliable diagnostic parameter for the differential diagnosis of septic arthritis from non-septic arthritis.
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