术前应用甲强龙能减少全膝关节置换术后早期血管内皮损伤相关因子

Pre-operative methylprednisolone decreased early vascular endothelial injury after total knee arthroplasty

目的探讨甲强龙对全膝关节置换术后早期血管内皮活化和损伤标志物的影响。 方法选取88例择期单侧全膝关节置换术患者,采用完全随机分组法分为两组(每组44例):术前分别静脉注射甲泼尼龙琥珀酸钠120 mg(甲强龙组)或等渗盐水(对照组)。所有手术均采用蛛网膜下腔-硬膜外联合麻醉,分别在术前及术后2、6、12、24 h采集血样,ELISA分析血管内皮细胞糖萼早期损伤的标志物多配体蛋白聚糖1(Syndecan-1)、血管内皮细胞损伤和活化标志物[血浆可溶性血栓调节蛋白(soluble thrombomodulin, sTM)和E-选择素]、血管内皮细胞渗透性标志物[血管内皮生长因子(vascular endothelial growth factor, VEGF)]和C-反应蛋白(C-reactive protein, CRP)浓度,记录两组患者并发症发生情况。 结果两组患者年龄、性别、BMI、手术时间和罗哌卡因剂量差异均无统计学意义(P>0.05)。与对照组比较,术后2、6、12 h和24 h甲强龙组Syndecan-1、E-选择素和CRP明显降低,术后6、12 h和24 h甲强龙组sTM和VEGF明显降低(P<0.05)。与术前比较,术后2、6、12 h和24 h甲强龙组Syndecan-1和E-选择素明显降低,CRP明显升高(P<0.05),术后6、12 h和24 h甲强龙组sTM和VEGF明显降低(P<0.05)。 结论术前给予甲强龙120 mg能减少全膝关节置换术后早期内皮活化,降低损伤的标志物水平,减轻全身炎症反应。

Objective To investigate the effect of methylprednisolone on markers of early vascular endothelial activation and damage after total knee arthroplasty. Methods We randomly selected 88 patients undergoing unilateral total knee arthroplasty. The patients were divided into two groups by a completely random grouping method(n=44), they were given either pre-operative intravenous methylprednisolone 120 mg (number of patients for methylprednisolone group) or isotonic saline (number of patients for control group). All operations were performed under lumbar spinal and epidural anesthesia. Blood samples were collected at 2, 6, 12 h and 24 h pre- and post-operation, respectively. By enzyme-linked immunosorbent assay(ELISA), we analyzed concentrations of Syndecan-1, plasma soluble thrombomodulin (sTM), E-selectin, vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) at different time points. Results There was no significant difference in age, gender, body mass index (BMI), operation time and ropivacaine dose between patients in two groups (P>0.05). Syndecan-1、E-selectin and CRP were significantly decreased at 2, 6, 12 h and 24 h in methylprednisolone group, sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group(P<0.05). Compared with preoperative, the level of Syndican-1 and E-selectin at 2, 6, 12 h and 24 h were significantly decreased, the level of CRP was significantly increased(P<0.05), the level of sTM and VEGF were significantly decreased at 6, 12 h and 24 h in methylprednisolone group (P<0.05). Conclusions Pre-operative administration of methylprednisolone 120 mg could reduce markers of endothelial activation, reduce the level of damage markers and reduce the systemic inflammatory response after total knee arthroplasty.