CAJ | 학술논문

目的探讨金属对金属人工全髋关节置换术后早期血清金属离子的变化及其对免疫功能的影响.方法将2008年1月至2010年12月期间在南京医科大学第一附属医院接受Durom大直径金属对金属人工全髋关节置换的32例(32髋)患者作为研究对象(Durom组),在同期接受金属对超高分子聚乙烯(Trilogy)人工全髋关节置换的患者中,根据患者年龄、性别、体重指数等选取与Durom组相匹配的32例作为Trilogy组,相同方法选取32位健康志愿者作为对照组.末次随访时,采用ICP-MS法检测患者血清钴、铬离子浓度,并通过检测外周血中血清C3、C4、IgA、IgG、IgM含量评估体液免疫的变化,检测T细胞亚群数量及Th细胞分泌功能评估细胞免疫功能的改变.结果 Durom组和Trilogy组所有患者均完成随访.Durom组平均随访时间为24.9个月(15～34个月),Trilogy组平均随访时间为25.53个月(15～48个月).末次随访时Durom组血清钴离子和铬离子浓度明显升高,分别为Trilogy组的4.33倍和1.95倍,Trilogy组和对照组血清钴离子和铬离子浓度无差异.Durom组与Trilogy组、对照组相比,血清C3、C4、IgA、IgG、IgM无明显差异.Durom组T细胞总数、CD4+和CD8+细胞数明显低于Trilogy组和对照组.对三组血清中的IFN-γ和IL-4进行检测,Durom组的IFN-γ明显高于Trilogy组和对照组,Trilogy组和对照组的IFN-γ无差异；三组的IL-4含量无明显差异.结论金属对金属人工全髋关节置换术后早期患者血清钴离子、铬离子浓度明显升高,对细胞免疫功能有一定程度的影响.
목적 탐토금속대금속인공전관관절치환술후조기혈청금속리자적변화급기대면역공능적영향.방법 장2008년1월지2010년12월기간재남경의과대학제일부속의원접수Durom대직경금속대금속인공전관관절치환적32례(32관)환자작위연구대상(Durom조),재동기접수금속대초고분자취을희(Trilogy)인공전관관절치환적환자중,근거환자년령、성별、체중지수등선취여Durom조상필배적32례작위Trilogy조,상동방법선취32위건강지원자작위대조조.말차수방시,채용ICP-MS법검측환자혈청고、락리자농도,병통과검측외주혈중혈청C3、C4、IgA、IgG、IgM함량평고체액면역적변화,검측T세포아군수량급Th세포분비공능평고세포면역공능적개변.결과 Durom조화Trilogy조소유환자균완성수방.Durom조평균수방시간위24.9개월(15～34개월),Trilogy조평균수방시간위25.53개월(15～48개월).말차수방시Durom조혈청고리자화락리자농도명현승고,분별위Trilogy조적4.33배화1.95배,Trilogy조화대조조혈청고리자화락리자농도무차이.Durom조여Trilogy조、대조조상비,혈청C3、C4、IgA、IgG、IgM무명현차이.Durom조T세포총수、CD4+화CD8+세포수명현저우Trilogy조화대조조.대삼조혈청중적IFN-γ화IL-4진행검측,Durom조적IFN-γ명현고우Trilogy조화대조조,Trilogy조화대조조적IFN-γ무차이；삼조적IL-4함량무명현차이.결론 금속대금속인공전관관절치환술후조기환자혈청고리자、락리자농도명현승고,대세포면역공능유일정정도적영향.
Objective To compare the serum metal ion levels and host immunologic response of patients received non-modular,large-head metal-on-metal total hip arthroplasty (THA,Durom) with those received modular titanium acetabular component (Trilogy) using conventional head sizes and metal-on-highly cross-linked polyethylene articulations at mean 2-year follow-up interval.Methods A continuous series of 32 consecutive patients (32 hips) accepted THA with a Durom large head metal-on-metal articulation between January 2008 and December 2010 was as study group (Durom Group).From all the patients who received THA with Trilogy prosthesis at the same period,32 patients matched the Durom group in age,gender and body mass index (BMI) were chosen to form the Trilogy group.Another 32 healthy volunteers also matched the Durom group were chosen to form the control group.At the final follow-up,the serum metal ion levels,host immunologic response were evaluated.Results The mean follow-up time for Durom group was 24.9 months (range,15-34 months) compared to 25.53 months (range,15-48 months) for Trilogy group.Co and Cr levels in Durom group were 4.33 and 1.95 times as high as those in Trilogy group.There was no statistically significant difference in serum C3,C4,IgA,IgG,IgM value in three groups.CD3+,CD4+ and CD8+cells in Durom group decreased significantly compared with Trilogy and control groups.The interferon-γ(IFN-γ) level in Durom group was significantly higher than that in Trilogy and control groups.Conclusion The serum cobalt and chromium levels in patients received Durom metal-on-metal THA elevated significantly in early period.Meanwhile,some amount of impact on host cell mediated immunity occurred.