肿瘤坏死因子样弱凋亡诱导因子在关节松动假体周围界膜中的表达及临床意义

Expressions and clinical significance of TWEAK in patients with aseptic loosening of prostheses

目的关节置换术后假体松动一直是关节外科的难题。文中通过探讨肿瘤坏死因子样弱凋亡诱导因子(tumor necrosis factor like weak inducer of apoptosis,TWEAK)在松动假体周围界膜中的表达及其临床意义,进一步了解假体松动的发生机制。方法收集7例髋关节翻修的界膜组织标本为界膜组,同时收集7例因股骨颈骨折行关节置换的髋关节滑膜组织标本为骨折滑膜组,7例因骨性关节炎行关节置换的髋关节滑膜组织标本为关节炎滑膜组。通过形态学观察并采用逆转录PCR(reverse transcription-PCR,RT-PCR)和Western blot检测TWEAK mRNA及TWEAK蛋白在标本中的表达。结果界膜组HE染色可见细胞增生明显并伴有局灶性大量炎性细胞浸润,免疫组化染色见大量TWEAK染色阳性细胞。RT-PCR检测TWEAK mRNA的表达:骨折滑膜组为0.216±0.016,关节炎滑膜组为0.318±0.021,界膜组为0.437±0.008;Western blot检测TWEAK蛋白的表达:骨折滑膜组为0.298±0.014,关节炎滑膜组为0.537±0.033,界膜组为0.715±0.062;TWEAK mRNA和TWEAK蛋白表达,组间两两比较差异均有统计学意义(P<0.05)。结论 TWEAK可能是炎性骨溶解的启动因素之一,进一步探索TWEAK在骨溶解中的作用机制,对临床防治人工关节无菌性松动具有重要意义。

Objective Prosthesis loosening is a problem of joint surgery. We studied the expressions and clinical significance of TWEAK in patients with aseptic loosening of prostheses,and tried to make clear the mechanism of prosthesis loosening. Methods Periprosthetic interface membranes（ 7 aseptic loosening of prostheses） were obtained as experimental group and synovial tissues were obtained（ 7 osteoarthritis patients and 7 fracture subjects） as control groups. Tissue sections were stained for general morphological characterization. TWEAK mRNA expression in tissues were examined by RT-PCR. TWEAK protein expression were examined by Western blot. Results HE staining showed that a large number of inflammatory cells infiltrated in periprosthetic interface membranes. Immunohistochemical staining also showed that the positive cells markedly increased. The expression levels of TWEAK mRNA was 0. 216 ± 0. 016 in the fracture synovial tissues group,0. 318 ± 0. 021 in osteoarthritis synovial tissues group,and 0. 437 ± 0. 008 in periprosthetic interface membranes group; The expression levels of TWEAK protein was 0. 298 ± 0. 014 in the fracture synovial tissues group,0. 537 ± 0. 033 in osteoarthritis synovial tissues group,and 0.715 ± 0. 062 in periprosthetic interface membranes group（ P〈0. 05）.Conclusion TWEAK may be the trigger of inflammatory osteolysis. It plays an important role in the pathogenesis of aseptic loosening.