双膝关节置换术后早期心肾损伤及固有免疫的变化  

Early myocardial and renal injury and the changes of innate immune responses after the operation of one-stage sequential bilateral total knee arthroplasty

作　　者：陈雯[1] 李晓玲[1] 齐迎春[1] 谢晓华[1] Chen Wen;Li Xiaoling;Qi Yingchun(Department of General Surgery,the Second Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心综合外科,北京100853

出　　处：《中华保健医学杂志》2021年第3期231-233,共3页Chinese Journal of Health Care and Medicine

基　　金：军队十二五重点科研课题资助(BWS12J051)。

摘　　要：目的观察一期序贯双侧全膝关节置换手术后早期心肾功能损伤、全身炎症反应及可能的固有免疫调节机制。方法选取2013年3月~6月在解放军总医院第一医学中心骨科住院、术中使用止血带的一期序贯双侧全膝关节置换手术患者15例,采用自身对照研究的方法,利用流式细胞技术观察术前24 h及术后4 h外周血CD14+单核细胞和中性粒细胞表面TOLL样受体4(Toll-like receptor 4,TLR4)表达的变化,同时观察手术前后血浆C反应蛋白(CRP)、白介素-6(IL-6)、人心型脂肪酸结合蛋白(heart fatty acid-binding protein,H-FABP)、肌酐(Cr)及尿液中肾损伤分子-1(kidney injury molecule-1,KIM-1)水平的变化。结果与术前24 h比较,术后4 h外周血CD14+单核细胞和中性粒细胞表面TLR4表达、血浆CRP、IL-6水平显著上升,血浆H-FABP及尿液KIM-1水平亦明显升高[(5.61±0.71)mg/L vs.(0.81±0.51)mg/L,(3.97±1.97)ng/L vs.(1.68±0.86)ng/L],差异有统计学意义(P<0.05)。术后4 h血清Cr水平较术前24 h变化差异无统计学意义(P>0.05)。结论一期序贯双侧全膝关节置换手术可造成术后早期炎症反应及心肾损伤,其机制可能与术后早期的固有免疫TLR4信号通路激活有关。Objective To observe the early myocardial and renal injury,systemic inflammatory response and the possible innate immune regulation mechanism in patients undergoing one-stage surgery involving sequential bilateral total knee arthroplasty(TKA).Methods:15 patients with one-stage sequential total knee arthroplasty with tourniquet-using were selected.The flow cytometry technique was used to detect the changes of Toll-like receptor 4(TLR4)expression of CD14+monocytes and neutrophils in peripheral blood before operation and in 4h after operation.The plasma levels of CRP,IL-6,heart fatty acid-binding protein(H-FABP)、Cr and urinary kidney injury molecule-1(KIM-1)level were measured at two time points..Results:Compared with in 24h before operation,the expression of TLR4 on the surface of CD14+monocytes and neutrophils in peripheral blood,the plasma levels of CRP and IL-6 were significantly upregulated in 4h after operation and in 12h after operation(P<0.05).The plasma H-FABP and urine Kim-1 levels in 4h after operation were also significantly increased than in 24h before operation[(5.61±0.71)mg/L vs(0.81±0.51)mg/L,(3.97±1.97)ng/L vs(1.68±0.86)ng/L,all P<0.05].There was no significant difference in plasma Cr level between post-operation and pre-operation(P>0.05).Conclusion:One-stage sequential bilateral total knee arthroplasty can cause system inflammatory response and myocardial and renal injury in early post-operation,which may be related to the early activation of innate immune TLR4 signaling pathway.

关 键 词：全膝关节置换术 炎症反应 心肾损伤 TOLL样受体4 

分 类 号：R687[医药卫生—骨科学]