髋关节置换术患者早期局部创伤血中相关细胞因子水平的动态变化同炎性反应的相关性

摘要

Objective To study about the loc al and subsequen systemic inflammatory reactions in early stage after total hip relplacement are rarely reported investigate the local and systemic cytokine kinetics in early stage after total hip replacement .Methods In 80 cases undergoing total hip replacement ,drained blood samples and venous blood samples were taken wound closure,1,4,and 24 hours after operation.Inteleukin6 ,tumor necrosis factor alpha(TNF-a)IL01Band IL-17 relases was assessed by enzyme-linked immunosorbent assay(ELISA)Results The major findings were significant increasesin systemic levels of IL-6 and in local levels of IL-7,and local levels of these cytokines were significantly higher than the systemic ones after operation .Besides,there were no significant changes in local and systemic levels of IL02Band IL017.Conclusion The acute sterile inflammation after major orthopaedic surgery is principally characterized by significantly increased local and systemic levels of IL=6.Furthermore,the systemic cytokine levels may not reflect local reactions.%　　目的观察全髋关节置换术后患者早期无菌性炎症阶段创伤局部引流血和全身循环血中相关细胞因子水平的动态变化。方法选择行全髋关节置换术患者80例，分别在关闭伤口时，置换后的1，4，24h采集静脉血样本及创伤局部引流学液样本，使用酶联免疫法分别检测血清中白细胞介素6，肿瘤坏死因子α，白细胞介素1β和白细胞介素17的水平。结果全髋关节置换术后患者早啊其创伤局部引流学和循环血中白细胞介素6的水平明显升高，且在各个时间点上创伤局部引流血中白细胞介素6水平丶高于循环血；置换后早期循环血液中肿瘤坏死因子α水平明显升高，创伤局部引流血肿瘤坏死因子α的水平无明显变化，但仍高于循环血中的水平白细胞介素1β和白细胞介素17的的水平在置换后无显著改变，且在创伤局部和循环中的含量无明显差异性。结论结果提示在全髋关节置换术后急性无菌性炎症阶段，循环血中炎性细胞因子的水平不会直接反应局部炎性反应的严重程度。