全膝关节置换假体松动时滑膜液中的诊断性标志物

Diagnostic markers in synovial fluid during prosthetic loosening after total knee arthroplasty

背景:人工关节置换后的无菌性假体松动一直是全膝关节置换后常见的并发症,是否与骨性关节炎的发生时的腱糖蛋白c、白细胞介素6和肿瘤坏死因子等许多细胞因子的作用密切相关?目的:观察全膝关节置换后无菌性假体松动发生时假体滑膜液中白细胞介素6、肿瘤坏死因子α和腱糖蛋白c的表达。方法:实验组选择45例全膝关节置换翻修患者,对照组为25例首次进行膝关节置换的患者。实验排除炎性关节炎、二次关节炎感染至全身或自身免疫病以及合并肝炎、恶性肿瘤、服用激素、免疫抑制剂等疾病史的患者。取各组患者假体滑膜液,Westernblot检测腱糖蛋白c剪切变异体的表达,ELISA分析假体滑膜液中白细胞介素6,肿瘤坏死因子α和腱糖蛋白c水平的变化。结果与结论:Western blot结果显示假体松动后假体滑膜液中存在大的腱糖蛋白c突变体。假体松动后滑膜液中白细胞介素6、腱糖蛋白c的水平大约是对照组的3倍,肿瘤坏死因子α水平大约是对照组的2.5倍。证实假体松动后假体滑膜液中腱糖蛋白c的含量升高,提示腱糖蛋白c可以作为诊断假体松动有效的标志物。

BACKGROUND： Aseptic loosening of the prosthesis is a common complication after total knee arthroplasty Whether the loosening of the prosthesis has relationship with the levels of tenascin-C, interleukin-6 and tumor necrosis factor is not clear. OBJECTIVE： To observe the expressions of interleukin-6, tumor necrosis factor a and tenascin-C of the patients with aseptic prosthesis loosening after total knee arthroplasty. METHODS： Forty-five patients treated with total knee arthroplasty and revision surgery were selected as the experimental group, and 25 patients treated with initial total knee arthroplasty were selected as the control group. In the experimental group, the patients with history of inflammatory arthritis, systemic secondary arthritis infection, autoimmune disease and combined hepatitis, malignant tumors, hormones orimmunosuppressants administration were eliminated. Synovial fluid samples of the prostheses in each group were obtained, and the expression of tenascin-C shear variants in synovial fluid was tested with Western-blot The levels of interleukin-6, tumor necrosis factor o and tenascin-C were analyzed with enzyme-linked immunosorbent assay. RESULTS AND CONCLUSION： Western blot results showed the presence of large tenascin-C variants in the synovial fluid of prostheses with loosening. The interleukin-6 and tenascin-C levels in the synovial fluid of prosthesis loosening were approximately three times higher than those in the control group, and tumor necrosis factor a level in the synovial fluid of prosthesis loosening was approximately 2.5 times higher than that in the control group. Levels of tenascin-C including large variant subunits are elevated in synovial fluid of prosthesis loosening, indicating that tenascin-C is a useful novel biochemical marker of prosthesis loosening.