全髋关节置换者深静脉血栓形成早期血浆细胞因子及细胞间黏附分子的变化

Changes in plasma cytokine and intercellular adhesion molecules in patients with early deep vein thrombosis after total hip replacement

目的:全髋关节置换者深静脉血栓形成是由内皮细胞损伤、血小板激活和凝血瀑布反应与抗凝、纤溶等机制共同作用的结果。了解全髋关节置换者深静脉血栓形成患者早期血浆炎症细胞因子表达以及细胞间黏附分子水平的变化,寻找相关预警指标。方法:①实验对象:选择2005-05/2007-05在沈阳市第七人民医院骨科住院进行全髋关节置换术治疗患者77例,83髋,男45例,女32例,年龄39～78岁,平均(65.09±18.74)岁。全部患者对全髋关节置换治疗知情同意,并自愿接受超声影像学检查以及各类实验室血清标本采集。施术者为同一组从事骨科临床工作≥7年的具有中级或副高级职称的骨科医生。②主要材料:全髋关节假体选用美国史赛克(中国)有限公司和北京普鲁复星外科植入物有限公司生产的APL非骨水泥柄和Muller骨水泥柄假体。材料采用精密锻造钛合金,表面用真空等离子钛或钛加羟基磷灰石喷涂,符合欧洲EN46001标准。③实验方法:入选对象均在全髋关节置换后1～7d采用彩色多普勒超声检查下肢深静脉血流通畅情况。采用酶联免疫吸附法测定白细胞CD18的表达,放射免疫方法测定血清肿瘤坏死因子α、白细胞介素6和白细胞介素10浓度。酶联免疫吸附法测定血浆可溶性细胞间黏附分子1和可溶性血管细胞间黏附分子1浓度。结果:①全髋关节置换中,超声检查发现深静脉血栓26例(血栓组),未发现静脉血栓者51例(对照组)。②血栓组全髋关节置换后1d和3d肿瘤坏死因子α、白细胞介素6和白细胞介素10炎症细胞因子表达指标明显高于对照组(P均<0.01～0.05)。③全髋关节置换后1d和3d时血栓组CD18、可溶性细胞间黏附分子1和可溶性血管细胞间黏附分子1表达明显高于对照组(P均<0.01～0.05)。结论:全髋关节置换后深静脉血栓形成患者早期相关血浆炎症细胞因子表达增强,细胞间黏附分子浓度明显增高,这些表现可能与深静脉血栓形成发生有关。

AIM：Deep vein thrombosis is induced by interaction of injury of endothelial cells, platelet activation, blood coagulation cascade with anti-coagulation and fibrinolysis in patients after total hip replacement. This study was to evaluate the changes in the expressions of plasma inflammatory cytokines and the levels of intercellular adhesion molecules to seek relevant warning indexes in patients with deep vein thrombosis early after total hip replacement. METHODS： ①Seventy-seven inpatients （83 hips） treated with total hip replacement were selected from the Department of Orthopaedics, Shenyang Seventh People＇s Hospital from May 2005 to May 2007, including 45 males and 32 females, aged 39 to 78 years old with an average age of （65.09±18.74） years old. Informed consent for total hip replacement was obtained from all the patients. All the patients accepted ultrasound imaging examination and various laboratory serum sampling collections voluntarily. The physicians were orthopedists with middle or associate senior professional title and worked in clinic at least 7 years. ②Total hip prosthesis were APL non-bone cement handle prosthesis and Muller bone cement handle prosthesis, which are produced by American Stryker Corporation （China） and Beijing Pulusi Fuxing Surgical Implant Co., Ltd. The materials were precisely forged titanium alloy, and the surface was sprayed with vacuum plasma titanium or titanium plus hydroxyapatite, which was accorded with European EN46001 standard. ③ Blood flow of deep vein in lower limbs was examined with color Doppler ultrasound in all the patients at 1-7 days after total hip replacement. The expression of leukocyte CD18 was determined with enzyme linked immunosorbent assay, and the concentrations of tumor necrosis factor alpha, interleukin-6 and interleukin-10 were determined with radioimmunoassay. The concentrations of plasma soluble intercellular adhesion molecular-1 and soluble vascular cell adhesion molecule-1 were determined with enzyme linked immunosorbent assay. RESULTS： ①Among all the patients after total hip replacement, the results of color Doppler ultrasound showed that 26 patients had deep vein thrombosis （thrombus group） and 51 patients had no deep vein thrombosis （control group）. ②The expressions of inflammatory cytokines of tumor necrosis factor alpha, interleukin-6 and interleukin-10 at 1 and 3 days postoperatively in the thrombus group were obviously higher than those in the control group （P 〈 0.01-0.05）. ③The levels of leukocyte CD18, plasma soluble intercellular adhesion molecular-1 and soluble vascular cell adhesion molecule-1 at 1 and 3 days postoperatively in most patients of the thrombus group were significantly higher than those in the control group （P〈0.01-0.05）. CONCLUSION： The expressions of related plasma inflammatory cytokines are enhanced, and the concentrations of intercellular adhesion molecular are obviously increased in patients with deep vein thrombosis early after total hip replacement.