Department of Biological Sciences, University of Chester, UK.
J Inflamm (Lond). 2010 Jan 19;7:2. doi: 10.1186/1476-9255-7-2.
It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR) and total knee replacement (TKR) orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively.
During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1) and CD62L cell surface expression, intracellular production of H(2)O(2 )and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF) and soluble intercellular adhesion molecule-1 (sICAM-1) were measured as markers of endothelial activation.
The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H(2)O(2 )production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery.
In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1-3 postoperatively. It is proposed that by allowing orthopaedic surgeons access to alternative laboratory markers such as CD11b, H(2)O(2 )and elastase, CD62L, vWF and sICAM-1, an accurate assessment of the extent of inflammation due to surgery per se could be made. Ultimately, the leukocyte and endothelial markers assessed during this investigation may have a role in monitoring potential infectious complications that can occur during the postoperative period.
据估计，英国有超过 800 万人患有骨关节炎。这些患者可能需要接受矫形外科手术干预，以帮助缓解他们的临床状况。本研究旨在测试以下假设：全髋关节置换术（THR）和全膝关节置换术（TKR）矫形外科手术会导致白细胞和内皮细胞标志物发生变化，从而增加术后炎症反应。
在这项“初步研究”中，由于骨关节炎的原因，10 名测试对象均计划接受 THR 或 TKR 择期手术。使用自动化全血计数分析仪测量白细胞浓度。白细胞 CD11b（Mac-1）和 CD62L 细胞表面表达、细胞内 H₂O₂和弹性蛋白酶的产生被作为白细胞功能的标志物进行测量。血管性血友病因子（vWF）和可溶性细胞间黏附分子-1（sICAM-1）被作为内皮细胞激活的标志物进行测量。
本研究获得的结果表明，THR 和 TKR 矫形外科手术导致白细胞和内皮细胞标志物发生相似的变化，提示术后炎症反应增加。具体而言，THR 和 TKR 手术后出现白细胞增多，表现为手术后总白细胞浓度增加。中性粒细胞和单核细胞 CD62L 表达减少和 CD11b 表达增加表明白细胞激活。术后中性粒细胞和单核细胞细胞内 H₂O₂产生和白细胞弹性蛋白酶浓度增加也表明白细胞激活。就内皮细胞激活而言，手术后 vWF 和 sICAM-1 浓度增加。
总的来说，在这些研究中测量的大多数白细胞和内皮细胞标志物似乎在术后 1-3 天达到峰值。有人提出，通过允许矫形外科医生获得替代的实验室标志物，如 CD11b、H₂O₂和弹性蛋白酶、CD62L、vWF 和 sICAM-1，可以对手术本身引起的炎症程度进行准确评估。最终，在这项研究中评估的白细胞和内皮细胞标志物可能在监测术后期间可能发生的潜在感染并发症方面发挥作用。
