Granchi D, Verri E, Ciapetti G, Stea S, Savarino L, Sudanese A, Mieti M, Rotini R, Dallari D, Zinghi G, Montanaro L
Laboratory for Biocompatibility Research on Implant Materials, Rizzoli Orthopaedic Institute, Bologna, Italy.
J Bone Joint Surg Br. 1998 Sep;80(5):912-7. doi: 10.1302/0301-620x.80b5.8513.
Our aim was to determine if the serum levels of bone-resorbing cytokines (IL-1beta, TNF-alpha, IL-6, GM-CSF) are altered in patients with aseptic loosening of a total hip prosthesis, and if such levels are influenced by the type of implant. We determined cytokine levels in sera from 35 patients before revision for failed total hip arthroplasty and compared them with those in 25 healthy donors. We also assessed the soluble receptor of interleukin-2 (sIL-2r) in serum as an indication of a specific immune reaction against the implant. Our findings showed that the sIL-2r and TNF-alpha serum level did not change. The IL-6 level was not significantly altered, but was higher in patients with TiAIV prostheses than in those with a CrCoMo implant and in patients with cemented prostheses. The IL-1beta level was found to be higher in those with a TiAIV cemented prosthesis than in the control group (p=0.0001) and other groups of patients (p=0.003 v uncemented TiAIV, p=0.01 v cemented CrCoMo, p=0.001 v uncemented CrCoMo). The GM-CSF level significantly increased in patients compared with healthy subjects (p=0.008), and it was higher in those with cemented than with uncemented implants (p=0.01). Only patients with cementless CrCoMo prostheses had levels of GM-CSF similar to those of the control group. The highest GM-CSF concentrations were observed in patients treated with non-steroidal anti-inflammatory drugs (NSAIDs) in the last months before revision (p=0.04). In addition, when massive osteolysis was observed, the level of GM-CSF tended to decrease to that of the control group.
我们的目的是确定全髋关节假体无菌性松动患者血清中骨吸收细胞因子（白细胞介素-1β、肿瘤坏死因子-α、白细胞介素-6、粒细胞-巨噬细胞集落刺激因子）水平是否发生改变，以及这些水平是否受植入物类型的影响。我们测定了35例全髋关节置换失败翻修术前患者血清中的细胞因子水平，并将其与25例健康供者的血清水平进行比较。我们还评估了血清中白细胞介素-2可溶性受体（sIL-2r），作为针对植入物的特异性免疫反应指标。我们的研究结果表明，sIL-2r和肿瘤坏死因子-α血清水平未发生变化。白细胞介素-6水平虽无显著改变，但钛铝钒（TiAIV）假体患者的该水平高于钴铬钼（CrCoMo）植入物患者及骨水泥固定假体患者。发现钛铝钒骨水泥固定假体患者的白细胞介素-1β水平高于对照组（p = 0.0001）及其他患者组（与非骨水泥固定钛铝钒假体患者相比，p = 0.003；与骨水泥固定钴铬钼假体患者相比，p = 0.01；与非骨水泥固定钴铬钼假体患者相比，p = 0.001）。与健康受试者相比，患者的粒细胞-巨噬细胞集落刺激因子水平显著升高（p = 0.008），骨水泥固定植入物患者的该水平高于非骨水泥固定植入物患者（p = 0.01）。仅非骨水泥固定钴铬钼假体患者的粒细胞-巨噬细胞集落刺激因子水平与对照组相似。在翻修术前最后几个月使用非甾体抗炎药（NSAIDs）治疗的患者中观察到最高的粒细胞-巨噬细胞集落刺激因子浓度（p = 0.04）。此外，当观察到大量骨溶解时，粒细胞-巨噬细胞集落刺激因子水平往往降至对照组水平。
