Department of Orthopaedics, Oslo University Hospital/Rikshospitalet, Oslo, Norway.
Scand J Clin Lab Invest. 2011 Oct;71(6):486-91. doi: 10.3109/00365513.2011.587529. Epub 2011 Jul 4.
Danger patterns and pattern recognition receptors have been targets in the investigation and treatment of systemic inflammatory response syndrome and sepsis. Lipopolysaccharide (LPS)-binding protein (LBP) presents LPS and gram-positive bacterial cell wall products to the receptors TLR4/MD-2 and TLR2, respectively. Low concentrations of LBP stimulate responses to LPS and peptidoglycan, whereas higher concentrations inhibit these responses. Soluble CD14 (sCD14) presents the LBP-LPS complex to CD14-negative cells, and it modulates the biological activity of circulating LPS. In this study, we aimed to elucidate the physiological reactions to LBP and sCD14 after total hip replacement surgery during spinal/epidural anaesthesia.
Seven patients with coxarthrosis were operated upon with a total hip replacement, which is a defined trauma to bone and muscles in conjunction with a certain amount of blood loss. Venous blood samples were taken before the operation and at 1 h, 3 days and 6 days after surgery. LBP and sCD14 were measured by conventional ELISA. To correct for hemodilution, each parameter was adjusted for hematocrit. A panel of cytokines was measured using Luminex technology to evaluate the trauma reaction.
IL-6 levels peaked 24 h after the operation, whereas IL-1β and IL-10 levels remained unchanged. Systemic levels of LBP were increased 24 h after surgery, whereas sCD14 remained steady. However, the dilution-corrected sCD14 values increased significantly, and the levels of both LBP and sCD14 peaked at day 3 after surgery.
Aseptic trauma primes the innate immune system for the posttraumatic release of LBP and sCD14.
危险模式和模式识别受体一直是全身性炎症反应综合征和败血症研究和治疗的靶点。脂多糖（LPS）结合蛋白（LBP）分别将 LPS 和革兰阳性细菌细胞壁产物呈现给 TLR4/MD-2 和 TLR2 受体。低浓度的 LBP 刺激 LPS 和肽聚糖的反应，而较高浓度的 LBP 抑制这些反应。可溶性 CD14（sCD14）将 LBP-LPS 复合物呈现给 CD14 阴性细胞，并调节循环 LPS 的生物学活性。在这项研究中，我们旨在阐明在脊椎/硬膜外麻醉下全髋关节置换术后对 LBP 和 sCD14 的生理反应。
7 例髋关节骨关节炎患者接受全髋关节置换术，这是一种与一定量失血相关的骨骼和肌肉的明确创伤。在手术前、手术后 1 小时、3 天和 6 天采集静脉血样。通过常规 ELISA 测量 LBP 和 sCD14。为了校正血液稀释，每个参数均根据红细胞压积进行调整。使用 Luminex 技术测量一组细胞因子，以评估创伤反应。
术后 24 小时，IL-6 水平达到峰值，而 IL-1β 和 IL-10 水平保持不变。术后 24 小时全身 LBP 水平升高，而 sCD14 保持稳定。然而，经过稀释校正的 sCD14 值显著增加，LBP 和 sCD14 的水平均在术后第 3 天达到峰值。
无菌性创伤使先天免疫系统对 LPS 和 sCD14 的创伤后释放做好准备。
