Dynamic monitoring of plasma human alpha-defensin 1-3 and peripheral blood inflammatory markers after primary total knee arthroplasty

doi:10.12307/2023.642

Abstract

Abstract: BACKGROUND: Previous studies demonstrated that synovial fluid human α-defensin 1-3 can provide a high accuracy for diagnosing periprosthetic joint infection. However, arthrocentesis is an invasive manipulation that repeated examination may increase the risk of developing periprosthetic joint infection and confuse the orthopedists on the cause and onset time of the disease so that it is unsuitable for conventional dynamic detection after total knee arthroplasty. Oppositely, peripheral blood tests have the advantages of micro-trauma, convenient access to samples and possibility of continuous and dynamic monitoring. However, no study about the changes of human α-defensin 1-3 content in plasma following primary total knee arthroplasty has been published by now.
OBJECTIVE: To observe the dynamic changes of human α-defensin 1-3 content in plasma and inflammatory marker levels in peripheral blood following primary total knee arthroplasty, so as to provide a new method for early screening for periprosthetic joint infection after total knee arthroplasty.
METHODS: From April to December 2015, patients who had undergone unilateral primary total knee arthroplasty because of advanced knee osteoarthritis were prospectively included in the study. The inflammatory marker levels in peripheral blood were tested on the preoperative day and postoperative 1, 3, 5 days, 2 weeks, 1, and 3 months. Sandwich enzyme-linked immunosorbent assay was used to detect the content of plasma human α-defensin 1-3.
RESULTS AND CONCLUSION: Finally, 27 patients were included in the study. The postoperative level of C-reactive protein and erythrocyte sedimentation rate in peripheral blood showed a rise first followed by a decline defined single-peaked change pattern. The content of white blood cell, neutrophil and neutrophil percentage in peripheral blood and human α-defensin 1-3 in plasma showed a double-peaked change pattern. That was, after the arthroplasty, it first rose and then fell, and then rose again and then fell again. The changing rate and extent of plasma human α-defensin 1-3 were more obvious than peripheral blood white blood cell, neutrophil and neutrophil percentage. The prominent “bimodal situation” suggests that plasma human α-defensin 1-3 may be a good biomarker for dynamic monitoring of inflammatory activity after total knee arthroplasty, which provides new ideas and evidence for monitoring and diagnosing periprosthetic infection after total knee arthroplasty.

Key words: total knee arthroplasty, periprosthetic joint infection, dynamic change, plasma human alpha defensin

CLC Number:

Chen Jinlun, Deng Peng, Ye Pengcheng, Cao Houran, Zeng Huiliang, Feng Wenjun, Zeng Jianchun, Zeng Yirong. Dynamic monitoring of plasma human alpha-defensin 1-3 and peripheral blood inflammatory markers after primary total knee arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(27): 4304-4311.

Figures/Tables 9

将各项炎性指标在7个不同采血时间节点值做两两对比。结果显示，全膝关节置换前的血浆人α防御素1-3水平分别与置换后第1，3，5天、2周、1个月比较差异均有显著性意义，而置换前与置换后3个月的比较差异无显著性意义，置换后第1天分别与置换后第3，5天、2周比较差异无显著性意义，而置换后第1天与置换后1，3个月比较差异有显著性意义。全膝关节置换前的血清C-反应蛋白、红细胞沉降率、白细胞计数、中性粒细胞百分比分别与置换后第1，3，5天、2周比较差异均有显著性意义，而与置换后1，3个月比较差异均无显著性意义。然而，全膝关节置换前的血清中性粒细胞计数分别与置换后第1，3，5天、2周、1个月比较差异均有显著性意义，但是与置换后3个月比较差异无显著性意义。血清C-反应蛋白的波动曲线显示其在置换后第1-3天时间内升高，到置换后第3天上升至“峰值”，随后慢慢下降至置换前的基础水平。血清红细胞沉降率的波动曲线显示其在置换后1-5 d时间内逐步上升，至置换后第5天即上升至“峰值”，随后逐步在1个月时间内下降置换前的基础水平，呈现出“单峰值”波动态势。血清白细胞计数、中性粒细胞计数、中性粒细胞百分比的水平波动情况基本类似，均在置换后第1天即上升到“峰值”，意外的是，与血清C-反应蛋白、红细胞沉降率不同，白细胞计数、中性粒细胞计数、中性粒细胞百分比在置换后第1-3天时间内下降，在置换后第3天时下降速度开始变慢，随后置换后第5天发生略微小幅度上升，均在置换后2周时上升至“第二次小峰值”，同样呈现出“双峰值”波动态势。此外，具体统计了27例患者中分别出现“双峰状”和“单峰状”的情况，结果显示23例患者的血浆人α防御素1-3水平在7个采血时间节点的波动呈现为“双峰状”态势(占总数的85.2%)，而只有4例患者的血浆人α防御素1-3水平的波动呈现“单峰状”态势(占总数的14.8%)。23例患者血浆人α防御素1-3水平变化中，21例患者的血浆人α防御素1-3首次升高在置换前，2例首次升高在置换后第3天，见图6。在2次升高的峰值人数比值统计中，18例在置换后第1天时发生第1次峰值，5例在置换后第3天时发生第1次峰值；17例在置换后2周时发生第1次峰值，3例在置换后1个月时发生第2次峰值，2例在置换后第5天时发生第2次峰值，1例在置换后3个月时发生第2次峰值，总计有91.3%的患者的“第2次峰值”出现在置换2周以后，见图7。"

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