初次全膝关节置换后血浆人α防御素1-3及外周血炎性指标的动态监测  

Dynamic monitoring of plasma human alpha-defensin 1-3 and peripheral blood inflammatory markers after primary total knee arthroplasty

作　　者：陈锦伦 邓鹏 叶鹏程 曹厚然 曾会粮 冯文俊[1] 曾建春[1] 曾意荣[1] Chen Jinlun;Deng Peng;Ye Pengcheng;Cao Houran;Zeng Huiliang;Feng Wenjun;Zeng Jianchun;Zeng Yirong(Orthopedics Center,First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;First Clinical School of Medicine,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong Province,China;Department of Orthopedic Surgery,Guangdong Provincial Hospital of Chinese Medicine,Guangzhou 510000,Guangdong Province,China;Department of Orthopedic Surgery,Foshan Hospital of TCM,Foshan 528000,Guangdong Province,China)

机构地区：[1]广州中医药大学第一附属医院骨伤中心,广东省广州市510405 [2]广州中医药大学第一临床医学院,广东省广州市510405 [3]广东省中医院骨科,广东省广州市510000 [4]佛山市中医院骨科,广东省佛山市528000

出　　处：《中国组织工程研究》2023年第27期4304-4311,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年科学基金项目(82104882),项目负责人:冯文俊;广东省中医药局科研项目(20201099),项目负责人:陈锦伦。

摘　　要：背景:研究表明关节滑液人α防御素1-3诊断假体周围感染的准确性较高,但关节穿刺对手术部位具有创伤性,不利于全膝关节置换后常规动态监测,长期重复检查可能会增加发生假体周围感染的风险,干扰骨科医生判断假体周围感染发生的原因与时间。外周血检测具有创伤小、标本获取容易、利于动态监控的优点,但目前国内外尚无初次全膝关节置换后血浆人α防御素1-3动态变化规律观察的相关研究。目的:观察初次全膝关节置换后血浆人α防御素1-3和外周血炎性指标的动态变化规律,为全膝关节置换后假体周围感染的早期筛查提供新的思路。方法:前瞻性纳入2015年4-12月因晚期膝骨关节炎行初次单侧全膝关节置换的患者,分别在全膝关节置换前、置换后第1,3,5天、置换后2周及置换后第1,3个月检测外周血炎性指标,并采用三文治夹心酶联免疫吸附法检测血浆人α防御素1-3水平。结果与结论:最终共27例患者纳入研究。初次全膝关节置换后外周血C-反应蛋白、红细胞沉降率呈现“单峰状”动态变化,即置换后先升高后下降;外周血白细胞计数、中性粒细胞计数、中性粒细胞百分比及血浆人α防御素1-3均呈现“双峰状”动态变化,即置换后先升高后下降,再次升高后再次下降。血浆人α防御素1-3的升降速度与幅度均较外周血白细胞计数、中性粒细胞计数、中性粒细胞百分比更加明显。突出的“双峰态势”提示血浆人α防御素1-3或许是全膝关节置换后动态监控炎症活动的良好生物标志物,可为全膝关节置换后监测并诊断关节假体周围感染提供了新思路和佐证。BACKGROUND: Previous studies demonstrated that synovial fluid human α-defensin 1-3 can provide a high accuracy for diagnosing periprosthetic joint infection. However, arthrocentesis is an invasive manipulation that repeated examination may increase the risk of developing periprosthetic joint infection and confuse the orthopedists on the cause and onset time of the disease so that it is unsuitable for conventional dynamic detection after total knee arthroplasty.Oppositely, peripheral blood tests have the advantages of micro-trauma, convenient access to samples and possibility of continuous and dynamic monitoring.However, no study about the changes of human α-defensin 1-3 content in plasma following primary total knee arthroplasty has been published by now.OBJECTIVE: To observe the dynamic changes of human α-defensin 1-3 content in plasma and inflammatory marker levels in peripheral blood following primary total knee arthroplasty, so as to provide a new method for early screening for periprosthetic joint infection after total knee arthroplasty.METHODS: From April to December 2015, patients who had undergone unilateral primary total knee arthroplasty because of advanced knee osteoarthritis were prospectively included in the study. The inflammatory marker levels in peripheral blood were tested on the preoperative day and postoperative 1, 3, 5days, 2 weeks, 1, and 3 months. Sandwich enzyme-linked immunosorbent assay was used to detect the content of plasma human α-defensin 1-3.RESULTS AND CONCLUSION: Finally, 27 patients were included in the study. The postoperative level of C-reactive protein and erythrocyte sedimentation rate in peripheral blood showed a rise first followed by a decline defined single-peaked change pattern. The content of white blood cell, neutrophil and neutrophil percentage in peripheral blood and human α-defensin 1-3 in plasma showed a double-peaked change pattern. That was, after the arthroplasty, it first rose and then fell, and then rose again and then fell again. The changing rate and ex

关 键 词：全膝关节置换 假体周围感染 动态变化 血浆人α防御素 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687.4