本文選題：α防御素 + 全膝關(guān)節(jié)置換術(shù)�。� 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：觀察肝腎虧虛型膝關(guān)節(jié)骨性關(guān)節(jié)炎患者行單側(cè)全膝關(guān)節(jié)置換術(shù)后血漿HNP1-3與外周血炎性指標(biāo)(CRP、ESR、WBC、NEU、NEU%)的動(dòng)態(tài)變化規(guī)律,探討聯(lián)合檢測(cè)外周血HNP1-3與外周血炎性指標(biāo)早期診斷PJI的可行性,為TKA術(shù)后PJl的早期篩查提供新的思路。方法：本研究依據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)納入自2015年4月至2015年12月因晚期膝關(guān)節(jié)骨性關(guān)節(jié)炎在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院行初次單側(cè)人工全膝關(guān)節(jié)置換術(shù)的患者,中醫(yī)辨病辨證為肝腎虧虛型膝痹病。記錄入選患者性別、年齡、體重、身高、體重指數(shù)、手術(shù)時(shí)間等一般資料,分別于全膝關(guān)節(jié)置換術(shù)前、術(shù)后第1天、術(shù)后第3天、術(shù)后第5天、術(shù)后2周、術(shù)后1個(gè)月及術(shù)后3個(gè)月空腹?fàn)顟B(tài)下對(duì)入選患者進(jìn)行抽血檢查,其中外周血CRP、 ESR、WBC、NEU和NEU%含量均由廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院檢驗(yàn)科完成,采用三文治夾心ELISA成批檢測(cè)血漿HNP1-3含量。研究數(shù)據(jù)分析采用SPSS 22.0軟件錄入和處理,數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差表示,采用單組重復(fù)測(cè)量資料的方差分析做統(tǒng)計(jì)學(xué)處理,P0.05定義為有統(tǒng)計(jì)學(xué)意義,應(yīng)用Excel軟件繪制各指標(biāo)的動(dòng)態(tài)變化圖。成果：共27位患者納入本研究,研究結(jié)果顯示外周血CRP在全膝關(guān)節(jié)置換術(shù)后第1-3天迅速上升,術(shù)后第3天升至峰值,隨后出現(xiàn)“雙相”下降現(xiàn)象,即術(shù)后第3天至術(shù)后2周這段時(shí)間內(nèi)迅速下降,術(shù)后2周以后變?yōu)榫徛陆?術(shù)后1個(gè)月降至術(shù)前水平。外周血ESR在術(shù)后第1-3天緩慢升高,在術(shù)后第5天達(dá)到峰值,之后緩慢下降,其中術(shù)后第3天至術(shù)后2周外周血ESR波動(dòng)幅度較小,出現(xiàn)“平臺(tái)”現(xiàn)象,但含量處于較高水平,于術(shù)后1個(gè)月恢復(fù)至術(shù)前水平。外周血WBC、NEU、NEU%均在術(shù)后第1天即升高至峰值,峰值過(guò)后,與ESR與CRP相反,三者在術(shù)后第1-3天迅速下降,術(shù)后第3天后下降速度明顯減慢,術(shù)后第5天開(kāi)始出現(xiàn)小幅度升高,術(shù)后2周升高到第二次峰值,之后緩慢下降,WBC、NEU%在術(shù)后1個(gè)月恢復(fù)至術(shù)前水平,NEU在術(shù)后3個(gè)月恢復(fù)至術(shù)前水平。術(shù)后血漿HNP1-3迅速上升,術(shù)后1天即達(dá)到峰值,術(shù)后1天以后緩慢下降,術(shù)后第5天以后再次出現(xiàn)升高,術(shù)后2周升高至第二次峰值,術(shù)后2周之后開(kāi)始迅速下降,直至術(shù)后3個(gè)月恢復(fù)術(shù)前水平,其中術(shù)后2周至術(shù)后1個(gè)月下降較明顯。血漿HNP1-3的升降速度與幅度均較外周血WBC、NEU、NEU%明顯,術(shù)后2周血漿HNP1-3含量較術(shù)后第5天增長(zhǎng)了約14.2%,外周血WBC、NEU、NEU%分別增長(zhǎng)了2.3%、3.7%、0.09%。結(jié)論：全膝關(guān)節(jié)置換術(shù)后患者血漿HNP1-3的含量變化對(duì)外周血中性粒細(xì)胞的含量變化具有一定的“放大效應(yīng)”,即來(lái)源于中性粒細(xì)胞的HNP1-3含量的變化程度較外周血中性粒細(xì)胞含量的變化程度明顯。血漿HNP1-3可能是TKA術(shù)后動(dòng)態(tài)監(jiān)控炎癥活動(dòng)的良好工具,但其確切性與有效性仍有待進(jìn)一步研究。
[Abstract]:Objective: to observe the dynamic changes of plasma HNP1-3 and peripheral blood inflammatory indexes in patients with osteoarthritis due to deficiency of liver and kidney after unilateral total knee arthroplasty. To explore the feasibility of combined detection of peripheral blood HNP1-3 and peripheral blood inflammatory markers for early diagnosis of PJI, and to provide a new idea for early screening of PJl after TKA. Methods: according to the inclusion criteria and exclusion criteria, the first unilateral total knee arthroplasty was performed in the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine from April 2015 to December 2015. TCM syndrome differentiation is liver and kidney deficiency type knee arthralgia. Gender, age, weight, height, body mass index and operation time were recorded before, 1 day, 3 days, 5 days, 2 weeks after total knee arthroplasty, respectively. Blood samples were taken from the selected patients 1 month after operation and 3 months after operation. The contents of CRP, ESR WBCU and neu% in peripheral blood were all completed by the Laboratory Department of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine. The content of plasma HNP1-3 was determined by sandwich ELISA. The data analysis was recorded and processed by SPSS 22.0 software, the data was expressed as mean 鹵standard deviation, and the variance analysis of single group of repeated measurements was defined as statistical significance. Use Excel software to draw the dynamic change diagram of each index. Results: a total of 27 patients were included in this study. The results showed that peripheral blood CRP increased rapidly on the 1-3 days after total knee arthroplasty, peaked on the third day after operation, and then showed a "biphasic" decline. From the 3rd day to the 2nd week after the operation, it decreased rapidly, then slowly decreased after 2 weeks, and decreased to the preoperative level 1 month after the operation. Peripheral blood ESR increased slowly on the 1-3 days after operation, reached its peak on the 5th day after operation, and then decreased slowly. The fluctuation of peripheral blood ESR was relatively small from the third day to the second week after operation, and the phenomenon of "platform" appeared, but the content was at a higher level. It recovered to the preoperative level 1 month after operation. The percentage of peripheral blood WBC neuneu% increased to the peak on the first day after operation. After the peak value, ESR and CRP decreased rapidly on the 1-3 days after operation, the decrease rate slowed down obviously on the third day after operation, and began to increase slightly on the 5th day after operation. At 2 weeks after operation, it increased to the second peak, and then decreased slowly to the preoperative level 1 month after the operation, and NEU to the preoperative level 3 months after the operation. Plasma HNP1-3 increased rapidly, reached the peak at 1 day after operation, decreased slowly after 1 day, increased again after 5 days, rose to the second peak at 2 weeks after operation, and began to decrease rapidly 2 weeks after operation. The level of preoperation was restored to 3 months after operation, and the decrease was more obvious from 2 weeks to 1 month after operation. The rising and falling speed and amplitude of plasma HNP1-3 were significantly higher than that of peripheral blood WBC neuneu%. The plasma HNP1-3 content increased about 14. 2% at 2 weeks after operation compared with that on the 5th day after operation, and the increase of 3. 7% in peripheral blood increased by 2. 3% and 0. 09% respectively on the 5th day after operation. Conclusion: the change of plasma HNP1-3 content in patients with total knee arthroplasty has a certain "amplification effect" on the changes of neutrophil content in peripheral blood. The change of HNP1-3 content from neutrophils was more obvious than that of peripheral blood neutrophilic granulocytes. Plasma HNP1-3 may be a good tool for dynamic monitoring of inflammatory activity after TKA, but its accuracy and effectiveness need to be further studied.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.9

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