严志强 解绪红 冯凌思 刘永轶

【摘要】 目的：探討外周血单个核细胞（PBMC）中核因子-κB（NF-κB）mRNA表达和血清白介素-6（IL-6）水平与膝关节置换术（TKA）术后下肢深静脉血栓形成（DVT）的关系。方法：选择2017年4月-2021年3月在广东省佛山市高明区人民医院行TKA的123例患者作为研究对象，术后根据彩超诊断结果判断是否有血栓形成，分为血栓组和正常组，比较两组一般资料和PBMC中NF-κB mRNA相对表达量、血清IL-6水平差异。根据DVT严重程度将血栓组分为轻度组、中度组和重度组，比较三组上述各指标差异，分析上述指标和DVT严重程度的相关性。采用多因素logistic回归分析TKA术后DVT危险因素。结果：TKA术后预防性用药后21例（17.07%）患者出现DVT，血栓组BMI≥28 kg/m2、术前诊断类风湿性关节炎（RA）患者的比例均显著高于正常组（P<0.05）。血栓组PBMC中NF-κB mRNA相对表达量和血清IL-6水平均显著高于正常组，且随着DVT严重程度增加而升高，Spearman相关分析显示两者与DVT严重程度均呈正相关（P<0.05）。多因素logistic回归分析结果显示，BMI、RA、PBMC中NF-κB mRNA相对表达量和血清IL-6水平均是TKA术后DVT的独立危险因素（P<0.05）。结论：PBMC中NF-κB mRNA高表达和血清IL-6水平升高均与TKA术后DVT有关。对于肥胖、术前诊断RA患者行TKA且术后PBMC中NF-κB mRNA高表达和血清IL-6水平明显升高者应提早做好预防措施，降低DVT发生的风险。

【关键词】 膝关节置换术 下肢深静脉血栓形成 核因子-κB 白介素-6

[Abstract] Objective： To study the relationship between nuclear factor-κB （NF-κB） mRNA expression in peripheral blood mononuclear cells （PBMC） and serum interleukin-6 （IL-6） level and deep vein thrombosis （DVT） of lower limbs after knee replacement （TKA）. Method： A total of 123 patients who underwent TKA in Foshan Gaoming District People Hospital from April 2017 to March 2021 were selected as the research objects. After operation， they were divided into thrombus group and normal group according to the results of color Doppler ultrasound diagnosis. The general data， the relative expression of NF-κB mRNA in PBMC and the serum IL-6 level of two groups were compared. According to the severity of DVT， they were divided into mild group， moderate group and severe group. The differences of the above indicators among three groups were compared and the correlation between the above indicators and the severity of DVT was analyzed. Multivariate logistic regression was used to analyze the risk factors of DVT after TKA. Result： DVT occurred in 21 cases （17.07%） after preventive medication after TKA. The BMI≥28 kg/m2 and the proportion of patients diagnosed with rheumatoid arthritis （RA） before operation in thrombus group were significantly higher than those in normal group （P<0.05）. The relative expression of NF-κB mRNA in PBMC and the serum IL-6 level in thrombus group were significantly higher than those in normal group， and increased with the increase of DVT severity. Spearman correlation analysis showed that both of them were positively correlated with DVT severity （P<0.05）. The multivariate logistic regression analysis showed that BMI， RA， the relative expression of NF-κB mRNA in PBMC and serum IL-6 level were independent risk factors of DVT after TKA （P<0.05）. Conclusion： The high expression of NF-κB mRNA in PBMC and the increase of serum IL-6 level are related to DVT after TKA. For obesity， those patients with RA diagnosed by TKA before operation， those NF-κB mRNA expression in PBMC and serum IL-6 level increased significantly after operation， should take preventive measures in advance to reduce the risk of DVT.

[Key words] Total knee arthroplasty Deep venous thrombosis of lower limbs Nuclear factor-κB Interleukin-6

First-authors address： Foshan Gaoming District Peoples Hospital， Foshan 528500， China

doi：10.3969/j.issn.1674-4985.2021.18.001

全膝关节置换术（TKA）对多种膝关节疾病终末期的治疗效果显著。随着我国老龄化加剧，手术量逐年递增，其相关并发症发生率亦逐年增加，其中下肢深静脉血栓形成（DVT）是术后常见并发症之一，也是导致肺栓塞（PE）甚至死亡的主要原因[1]。目前，较多学者对TKA术后并发DVT的危险因素和发病机制进行研究，但尚未形成统一定论[2]。早期对DVT进行监测、评估并及时处理非常重要。有研究表明，外周血炎症细胞因子水平及其上游基因参与DVT形成[3-6]。核因子-κB（NF-κB）是控制DNA转录、调节炎症反应及免疫应答的核心转录因子，可启动多种炎症基因的表达，其可能促进血小板活化、聚集等过程，参与DVT形成[7-8]。本研究通过检测TKA术后DVT患者外周血单个核细胞（PBMC）中NF-κB mRNA相对表达量和血清白介素-6（IL-6）水平，以观察两者与TKA术后DVT形成的关系。……