摘要
目的本研究旨在通过检测关节假体周围组织中白介素-1受体相关激酶M(IRAK-M)的表达情况,探讨各种界膜中的表达差异及其临床意义。方法选取中山大学附属第一医院关节外科人工髋关节置换(THA)患者作为研究对象,排除免疫系统紊乱、免疫功能缺陷及结缔组织病。对初次THA,术中收集滑膜或关节囊组织;对无菌性松动及假体感染患者,翻修术中收集髋臼侧及股骨侧假体周围界膜组织。按照常规免疫组化操作规程进行染色,显微镜下观察IRAK-M的表达情况。多组间采用Kruskal-Wallis H检验,两独立样本计量资料采用的t检验,两组间阳性表达百分比采用Mann-Whitney U检验,P<0.05表示差异有统计学意义。结果通过免疫组化检测发现假体感染、无菌性松动的界膜IRAK-M蛋白高表达,且IRAK-M染色阳性细胞几乎仅见于单核巨噬细胞和多核巨细胞,两种类型的松动界膜表达程度无明显统计学差异(P>0.05),而对照组骨关节炎滑膜IRAK-M表达不明显。结论IRAK-M在假体周围的界膜中有着高表达,可能参与免疫耐受,导致关节置换术后,局部抗感染免疫下降。
Objective To detect the expression of interleukin-1 receptor-associated kinase-M（IRAKM） in periprosthetic tissues,and explore the effect and discrepancy of IRAK-M in different interface membranes. Methods A total of 45 osteoarthritis（OA） patients for total hip arthroplasty（THA） were selected in the joint surgery,First Affiliated Hospital of Sun Yat-sen University. All the patients were diagnosed clearly before operation, excluding immunological disorders, immunodeficiency diseases and connective tissue diseases. Intraoperative samples collection： the synovial membrane samples were obtained at primary total hip arthroplasty,and for aseptic and septic loosening,the interface membrane samples from two sites of each patient,stem and cup,were obtained during revision operation. According to conventional immunohisto-chemical rules,the slices were stained. IRAK-M was detectd by microscope. Multigroups were compared by Kruskal-Wallis H test,and the two independent samples by t test. The positive expression percentage between the two groups was measured by Mann-Whitney U test. A value of P 〈 0. 05 was regarded as statistically significant. Results The results showed that the interface membranes of septically and aseptically loosened prosthesis express more IRAK-M protein than control membranes from osteoarthritic patients,and indeed,in particular macrophages and multinucleated giant cells express IRAK-M. There is no significant difference between the two types of loosening（P 〉 0. 05）. However,the IRAK-M staining was quite scarce in OA synovial membranes,compared with interface membranes from aseptically and septically loosened hip joints. Conclusion The highly expression of IRAK-M in periprosthetic tissues may be involved in the immune tolerance,lead to the lower local anti-infection after arthroplasty.
作者
杨兴
盛璞义
余世明
李占春
张阳春
Yang Xing;Sheng Puyi;Yu Shiming;Li Zhanchun;Zhang Yangchun(Department of Orthopedics, First Affiliated Hospital of Sun Yatsen University, Guangzhou 510080, China;Osteoarticular Surgery, the First Affiliated Hospital of University of South China, Hengyang 421001, China)
出处
《中华关节外科杂志（电子版）》
CAS
2018年第2期168-173,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
