肝肾亏虚型膝OA单侧TKA术后血浆HNP1-3和外周血炎性指标的动态变化

发布时间：2018-05-08 05:09

本文选题：α防御素 + 全膝关节置换术　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：观察肝肾亏虚型膝关节骨性关节炎患者行单侧全膝关节置换术后血浆HNP1-3与外周血炎性指标(CRP、ESR、WBC、NEU、NEU%)的动态变化规律,探讨联合检测外周血HNP1-3与外周血炎性指标早期诊断PJI的可行性,为TKA术后PJl的早期筛查提供新的思路。方法：本研究依据纳入标准和排除标准纳入自2015年4月至2015年12月因晚期膝关节骨性关节炎在广州中医药大学第一附属医院行初次单侧人工全膝关节置换术的患者,中医辨病辨证为肝肾亏虚型膝痹病。记录入选患者性别、年龄、体重、身高、体重指数、手术时间等一般资料,分别于全膝关节置换术前、术后第1天、术后第3天、术后第5天、术后2周、术后1个月及术后3个月空腹状态下对入选患者进行抽血检查,其中外周血CRP、 ESR、WBC、NEU和NEU%含量均由广州中医药大学第一附属医院检验科完成,采用三文治夹心ELISA成批检测血浆HNP1-3含量。研究数据分析采用SPSS 22.0软件录入和处理,数据以均数±标准差表示,采用单组重复测量资料的方差分析做统计学处理,P0.05定义为有统计学意义,应用Excel软件绘制各指标的动态变化图。成果：共27位患者纳入本研究,研究结果显示外周血CRP在全膝关节置换术后第1-3天迅速上升,术后第3天升至峰值,随后出现“双相”下降现象,即术后第3天至术后2周这段时间内迅速下降,术后2周以后变为缓慢下降,术后1个月降至术前水平。外周血ESR在术后第1-3天缓慢升高,在术后第5天达到峰值,之后缓慢下降,其中术后第3天至术后2周外周血ESR波动幅度较小,出现“平台”现象,但含量处于较高水平,于术后1个月恢复至术前水平。外周血WBC、NEU、NEU%均在术后第1天即升高至峰值,峰值过后,与ESR与CRP相反,三者在术后第1-3天迅速下降,术后第3天后下降速度明显减慢,术后第5天开始出现小幅度升高,术后2周升高到第二次峰值,之后缓慢下降,WBC、NEU%在术后1个月恢复至术前水平,NEU在术后3个月恢复至术前水平。术后血浆HNP1-3迅速上升,术后1天即达到峰值,术后1天以后缓慢下降,术后第5天以后再次出现升高,术后2周升高至第二次峰值,术后2周之后开始迅速下降,直至术后3个月恢复术前水平,其中术后2周至术后1个月下降较明显。血浆HNP1-3的升降速度与幅度均较外周血WBC、NEU、NEU%明显,术后2周血浆HNP1-3含量较术后第5天增长了约14.2%,外周血WBC、NEU、NEU%分别增长了2.3%、3.7%、0.09%。结论：全膝关节置换术后患者血浆HNP1-3的含量变化对外周血中性粒细胞的含量变化具有一定的“放大效应”,即来源于中性粒细胞的HNP1-3含量的变化程度较外周血中性粒细胞含量的变化程度明显。血浆HNP1-3可能是TKA术后动态监控炎症活动的良好工具,但其确切性与有效性仍有待进一步研究。
[Abstract]:Objective: to observe the dynamic changes of plasma HNP1-3 and peripheral blood inflammatory indexes in patients with osteoarthritis due to deficiency of liver and kidney after unilateral total knee arthroplasty. To explore the feasibility of combined detection of peripheral blood HNP1-3 and peripheral blood inflammatory markers for early diagnosis of PJI, and to provide a new idea for early screening of PJl after TKA. Methods: according to the inclusion criteria and exclusion criteria, the first unilateral total knee arthroplasty was performed in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from April 2015 to December 2015. TCM syndrome differentiation is liver and kidney deficiency type knee arthralgia. Gender, age, weight, height, body mass index and operation time were recorded before, 1 day, 3 days, 5 days, 2 weeks after total knee arthroplasty, respectively. Blood samples were taken from the selected patients 1 month after operation and 3 months after operation. The contents of CRP, ESR WBCU and neu% in peripheral blood were all completed by the Laboratory Department of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine. The content of plasma HNP1-3 was determined by sandwich ELISA. The data analysis was recorded and processed by SPSS 22.0 software, the data was expressed as mean 卤standard deviation, and the variance analysis of single group of repeated measurements was defined as statistical significance. Use Excel software to draw the dynamic change diagram of each index. Results: a total of 27 patients were included in this study. The results showed that peripheral blood CRP increased rapidly on the 1-3 days after total knee arthroplasty, peaked on the third day after operation, and then showed a "biphasic" decline. From the 3rd day to the 2nd week after the operation, it decreased rapidly, then slowly decreased after 2 weeks, and decreased to the preoperative level 1 month after the operation. Peripheral blood ESR increased slowly on the 1-3 days after operation, reached its peak on the 5th day after operation, and then decreased slowly. The fluctuation of peripheral blood ESR was relatively small from the third day to the second week after operation, and the phenomenon of "platform" appeared, but the content was at a higher level. It recovered to the preoperative level 1 month after operation. The percentage of peripheral blood WBC neuneu% increased to the peak on the first day after operation. After the peak value, ESR and CRP decreased rapidly on the 1-3 days after operation, the decrease rate slowed down obviously on the third day after operation, and began to increase slightly on the 5th day after operation. At 2 weeks after operation, it increased to the second peak, and then decreased slowly to the preoperative level 1 month after the operation, and NEU to the preoperative level 3 months after the operation. Plasma HNP1-3 increased rapidly, reached the peak at 1 day after operation, decreased slowly after 1 day, increased again after 5 days, rose to the second peak at 2 weeks after operation, and began to decrease rapidly 2 weeks after operation. The level of preoperation was restored to 3 months after operation, and the decrease was more obvious from 2 weeks to 1 month after operation. The rising and falling speed and amplitude of plasma HNP1-3 were significantly higher than that of peripheral blood WBC neuneu%. The plasma HNP1-3 content increased about 14. 2% at 2 weeks after operation compared with that on the 5th day after operation, and the increase of 3. 7% in peripheral blood increased by 2. 3% and 0. 09% respectively on the 5th day after operation. Conclusion: the change of plasma HNP1-3 content in patients with total knee arthroplasty has a certain "amplification effect" on the changes of neutrophil content in peripheral blood. The change of HNP1-3 content from neutrophils was more obvious than that of peripheral blood neutrophilic granulocytes. Plasma HNP1-3 may be a good tool for dynamic monitoring of inflammatory activity after TKA, but its accuracy and effectiveness need to be further studied.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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