髋关节骨缺损患者术后免疫功能及细胞因子水平与关节功能的关系

Relationship between immune function and hip function in patients with hip joint bone defect after operation

目的 探讨髋关节骨缺损患者术后免疫功能及细胞因子水平与髋关节功能的关系.方法 选取2021年12月至2023年12月聊城市第二人民医院收治的33例髋关节骨缺损患者作为研究对象,所有患者行后外侧入路手术方式全髋关节翻修术.在患者术前和术后清晨抽取静脉血,分离血清和血细胞,采用流式细胞术分析T淋巴细胞亚群(CD3+、CD4+、CD8+和CD4+/CD8+、TH1/TH2、Treg)、和自然杀伤(NK)细胞水平;采用Harris髋关节功能评分表分析髋关节骨缺损患者术前术后髋关节功能情况.采用相关性分析免疫细胞比例(CD3+、CD4+、CD8+和CD4+/CD8+)和炎性因子[白细胞介素(IL)-4、IL-10和γ-干扰素(IFN-γ)]与Harris评分的关系.组间计量数据比较采用t检验.结果 髋关节骨缺损患者术后CD3+、CD4+、CD8+淋巴细胞比例和CD4+/CD8比值[(80.93±6.56)%、(53.20±5.29)%、(26.93±2.93)%、(1.58±0.05)]明显低于术前[(72.80±5.32)%、(45.53±6.56)%、(22.73±2.12)%、(1.25±0.10)],差异有统计学意义(t=7.903,7.340,7.171,17.610,P<0.05).髋关节骨缺损患者术后Th1/Th2比值和NK细胞比例[1.23±0.08、(13.12±1.92)%]明显低于术前 Th1/Th2 比值和 NK 细胞比例[1.49±0.17、(17.16±1.74)%],差异有统计学意义(t=7.928、8.763,P<0.05).髋关节骨缺损患者术后Treg比例比例[(7.06±0.64)%]明显高于术前Treg比例[(3.53±0.33)%],差异有统计学意义(t=27.900,P<0.05).髋关节骨缺损患者术后IL-4和IL-10水平[(52.03±10.13)、(43.42±8.56)pg/ml]明显高于术前 IL-4 和 IL-10 水平[(35.57±6.79)、(30.27±4.89)pg/ml],差异有统计学意义(t=7.746、7.665,P<0.05).髋关节骨缺损患者术后INF-γ水平(43.00±8.78)pg/ml明显高于术前INF-γ水平(22.30±3.75)pg/ml,差异有统计学意义(t=7.746,P<0.05).治疗前患者Harris髋关节功能评分(72.15±7.94)分明显低于治疗后患者髋关节评分(91.75±4.48)分,差异有统计学意义(t=12.340,P<0.05).Harris髋关节功能评分与CD3+、CD4+、CD8+淋巴细胞比例和CD4+/CD8比值呈负相关(r=-0.891、-0.778、-0.715,P<0.05).Treg 比例、IL-4 和 IL-10 水平与 Harris 髋关节功能评分呈负相关(r=-0.521、-0.891、-0.778,P<0.05).Th1/TH2 比值、NK 细胞比例、INF-γ水平Harris髋关节功能评分呈负相关(r=0.441、0.285、0.514,P<0.05).结论 髋关节置换术后髋关节骨缺损患者免疫功能明显改善,患者术后免疫功能与术后髋关节功能呈正相关.

Objective To investigate the relationship between immune function,cytokine level and hip joint function in patients with hip joint defect after surgery.Methods A total of 33 patients with hip bone defect admitted to The Second People's Hospital of Liaocheng City from December 2021 to December 2023 were selected as the study objects,all of whom underwent total hip revision through posterolateral ap-proach.Venous blood was drawn before and in the morning after surgery to separate serum and blood cells.T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+,TH1/TH2,Treg)and natural killer(NK)cells were analyzed by flow cytometry and Harris hip function scale was used to analyze the hip function of patients with hip defect before and after surgery.Correlation analysis was used to analyze the relationship between the proportion of immune cells(CD3+,CD4+,CD8+and CD4+/CD8+)and inflammatory fac-tors[interleukin(IL)-4,IL-10 and interferon-γ(IFN-γ)]and Harris score.T test was used to compare measurement data between groups.Results After surgery,the proportion of CD3+,CD4+,and CD8+lymphocytes and the CD4+/CD8 ratio in patients with hip bone defects were significantly lower than the preoperative values[(80.93±6.56)%,(53.20±5.29)%,(26.93±2.93)%,1.58±0.05 vs.(72.80±5.32)%,(45.53±6.56)%,(22.73±2.12)%,1.25±0.10,t=7.903,7.340,7.171,17.610,P<0.05].The Th1/Th2 ratio and the proportion of NK cells in patients with hip bone defects were significantly lower than the preoperative values[1.23±0.08,(13.12±1.92)%vs.1.49±0.17,(17.16±1.74)%,t=7.928,8.763,P<0.05].The proportion of regulatory T cells in patients with hip bone defects was significantly higher than the preoperative value[(7.06±0.64)%vs.(3.53±0.33)%,t=27.900,P<0.05].The levels of IL-4 and IL-10 in patients with hip bone defects after surgery[(52.03±10.13),(43.42±8.56)pg/ml]were significantly higher than the preoperative levels[(35.57±6.79),(30.27±4.89)pg/ml,t=7.746,7.665,P<0.05].The level of INF-y inpatients with hip bone defects after surgery[(43.00±8.78)pg/ml]was significantly higher than the preoperative level[(22.30±3.75)pg/ml,t=7.746,P<0.05].The preoperative hip joint function score of the pa-tients[(72.15±7.94)points]was significantly lower than the postoperative hip joint score of the patients[(91.75±4.48)points,t=12.340,P<0.05].Harris hip function score was negatively correlated with CD3+,CD4+,CD8+lymphocyte proportion and CD4+/CD8 ratio(r=-0.891,-0.778,-0.715,P<0.05).Treg proportion,IL-4 and IL-10 levels were negatively correlated with Harris hip function score(r=-0.521,-0.891,-0.778,P<0.05).Th1/TH2 ratio,NK cell proportion,and INF-y level were nega-tively correlated with Harris hip function score(r=0.441,0.285,0.514,P<0.05).Conclusion The im-mune function of patients with hip joint defect after hip joint replacement is significantly improved,and the immune function of patients after hip joint replacement is positively correlated with the hip joint function.