假体置入患者外周血白细胞Toll样受体2和4的表达

背景：研究证实全髋关节置换后松动假体表面生物膜中表达Toll样受体，但其变化规律尚不清楚。 目的：观察关节假体置入患者外周血白细胞Toll样受体2，4的表达。 方法：选择关节置换患者和同期10例行关节镜检查患者，于入院次日和假体置入后第3天早晨空腹抽取肘静脉血，流式细胞术分析外周血白细胞中Toll样受体2和Toll样受体4的阳性表达，同时送血样至检验科检查白细胞、血沉、C-反应蛋白水平。 结果与结论：两组白细胞、血沉、C-反应蛋白均在正常范围内。Toll样受体2，4均主要表达于外周血单核细胞，而在外周血淋巴细胞和中性粒细胞的表达率较低；关节置换组术后外周血单核细胞Toll样受体2阳性表达率明显低于术前(P < 0.05)；关节置换组Toll样受体4、关节镜组Toll样受体2，4手术前后阳性表达率差异无显著性意义(P > 0.05)。关节置换组手术前后外周血单核细胞Toll样受体2阳性表达率低于关节镜组(P < 0.05)，两组Toll样受体4表达率无差异。提示在无感染的情况下，手术本身应激和局部损伤不影响Toll样受体2，4的表达，假体的置入下调了外周血Toll样受体2的表达。

Toll-like receptor 2 and 4 expression in peripheral blood leukocytes of patients following prosthesis implantation

BACKGROUND: Toll-like receptors (TLRs) are expressed on the surface of biofilms in loosening hip prosthesis. However, the expression changes remain unclear. OBJECTIVE:To investigate the expression of TLR 2 and 4 in leukocytes of patients undergoing joint prosthesis implantation. METHODS:Fasting blood plasma samples were harvested from elbow veins 24 hours post admission and 3 days post-operation from patients undergoing arthroplasty or arthroscopy (n=10). Cell-associated TLR 2 and 4 was measured by flow cytometry, white blood cells, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were tested. RESULTS AND CONCLUSION: WBC, ESR, CRP were at normal level in both groups. TLR2 and 4 were mostly expressed in monocytes of peripheral blood, with low expression levels in lymphocytes and neutrophils. The expression levels of TLR2 was significantly reduced following operation (P < 0.05), but no significant difference was observed in the expression levels of TLR4 in arthroplasty group or TLR2 and 4 in arthroscopy group between post-operation and pre-operation (P > 0.05), whereas a significant change of TLR9 expression gap was found in arthroplasty patients before and after the procedure (P < 0.05). TLR 4 expression remained unchanged (P > 0.05). The TLR2 positive expression rate in monocytes of peripheral blood was significantly lower in arthroplasty group compared with arthroscopy group (P < 0.05), but no difference was found in TLR4 expression. Results show that in the absence of clinical infection, stress and tissue damage during arthroplasty and arthroscopy do not affect TLR2 and 4 expression, but TLR2 expression was downregulated following implantation of joint prosthesis.