| Orthopedic surgical site infection, the highest rate in all surgical site infection, often cause serious consequences. The doctor looking for methods to reduce the infection occurs, and predict infection early, seek methods for early treatment. The body’s immune system will play an important role in the process of infection.The past has been that RBC has simple structure, its function also single, only is a tool for transport of O2 and CO2. Siegel, etc in 1981, American scholars put forward the new concept of RBC immune system, since then, the red blood cells related to the natural immune molecules have been found. Associated with the immune substances(such as CD35, CD58, CD59, DAF, SOD enzyme and so on) numerous, its own system.Red blood cell immune function also gradually be recognized. Red blood cells has important immune function, has been proven to recognize, adhesion, killing antigen,eliminate circulating immune complex, at the same time many red blood cells involved in the body’s immune response and immune regulation, and has the complete self-regulation system. Red blood cells in whole blood volume percentage is about 50%,is the most important components of the blood.At present, the red cell immunology has become one of the most striking the research field of immune research. Guo-Feng, etc, the roadmap theory of blood immune system put forward more red blood cells, such as the important position in the body’s immunesystem to provide a theoretical basis. The roadmap theory is that: when pathogens(bacteria, viruses, etc.) into the body, after the first widely dissolved in plasma, red blood cells under complement the participation of the adhesive, a few can be directly removed, more pathogens will be transport to the reticuloendothelial system after red blood cell adhesion to macrophages clear; By adhesion of pathogens was also red blood cells on T and B lymphocytes, antibodies, and produce various kinds of immunomodulatory molecules(such as TNF alpha, IL- 2, the INF- gamma, IL- 10,PGE2), in the process of adaptive immune reaction to produce memory cells, to invasion of pathogenic agents happen fast adaptive immune response.Existing research objectively proved that red blood cell innate immune important role in blood immune reaction. More and more studies have confirmed the changes of red blood cell innate immune function and the occurrence and development of many diseases and has close relation with the pathological process. We observed the orthopaedic surgery on erythrocyte immune adherence function and influence on T cell immune regulating function. Detection of red cell membrane immune molecules CD35,CD58, the change of CD59, analysis the possible mechanism of erythrocyte immune function change and the red cell immune function changes associated with infection,inflammatory index the correlation of the ESR, CRP, WBC, expect to offer reference to look for ways to reduce the orthopaedic surgical infection.The first part: the artificial total hip replacement effects on erythrocyte immune adhesion functionObjective: to test the artificial total hip replacement surgery influence on erythrocyte immune adhesion function, to explore the causes of postoperative susceptible.Methods: Selection of femoral neck fracture line of artificial total hip replacement surgery patients, respectively in the preoperative and postoperative 1 day extracting peripheral venous blood of 4 ml, separation of red blood cells; Choose a set of medical healthy volunteers take 4 ml blood as a control; Three groups of red blood cells to detect natural tumor erythrocyte rosette rate(NTERR) by Guo Feng method, I complement receptor type rosette rate(RC3b RR).Results: RBC ’s natural tumor erythrocyte rosette rate(NTERR), I complement receptor type rosette rate(RC3b RR) before total hip arthroplasty was significantly lower than in healthy volunteers without(P> 0.05), significantly lower than the pre- surgery,intraoperative after also significantly lower than in healthy volunteers(p <0.05).Conclusion: Total hip arthroplasty erythrocyte immunity decreases, recognition,adhesion, anti- antigen clearance reduce the ability of circulating immune complexes may be one reason for postoperative infection.The second part: artificial total hip replacement effects on erythrocyte immune regulationObjective: Detection of artificial total hip replacement surgery influence on red blood cell immune regulation function, to explore the causes of postoperative susceptible.Methods: Selection of femoral neck fracture line of artificial total hip replacement surgery patients, respectively, in the preoperative and postoperative 1 day fromperipheral venous blood 4 ml, separation of red blood cells; Choose a group of healthy volunteers, extraction of 4 ml of blood, separation of lymphoid cells and red blood cells.Separation of the three groups of patients with red blood cells and lymphocyte volunteers training, testing on promoting lymphocyte proliferation rate of red blood cells; And testing within the culture of TNF alpha, IL- 2, INF- gamma, Fox P3, IL- 10,PGE2 levels.Results: Red blood cells on promoting lymphocyte proliferation rate of preoperative healthier has no obvious change, the preoperative and postoperative health significantly reduced; Culture within the TNF alpha, IL- 2, INF- gamma preoperative is no obvious change in healthy subjects, reduce the preoperative and postoperative health, IL- 10,PGE2 preoperative is no obvious change in healthy subjects, the preoperative and postoperative health significantly higher(p < 0.05), three groups of Fox P3 has no obvious change.Conclusion: Artificial red blood cells after total hip replacement on promoting lymphocyte proliferation ability is reduced, immune enhancement factor to reduce nutrient solution, higher immunosuppressive factor, it could also be one of the reasons for postoperative infection.The third part: after total hip arthroplasty erythrocyte immune molecules expression changesObjective: Detection of total hip replacement surgery on the impact of red cell membrane expression of immune molecules CD35, CD58, CD59 is to analyze the reasons for the change of erythrocyte immune.Methods: Selection of femoral neck fracture line of artificial total hip replacement surgery patients, respectively, in the preoperative and postoperative 1 day from peripheral venous blood 4 ml, separation of red blood cells; Choose a group of healthy volunteers, extraction of 4 ml of blood, Flow cytometry three groups of red cell membrane CD35, expression of CD58, CD59 ’s.Results: There was no significant difference(P> 0.05) before the red cell membrane CD35, CD58, CD59 expression in patients than in healthy volunteers, compared with the preoperative and postoperative health was significantly lower(p <0.05).Conclusion: Total hip arthroplasty erythrocyte immune molecules CD35, CD58, CD59 expression is reduced, which may be after erythrocyte immunity and immune regulation function of reasons for the decrease.The fourth part: fracture erythrocyte immune function and the correlation of the ESR, CRP, WBCObjective: Discussion after orthopedic surgery erythrocyte immune function changes with ESR, CRP, WBC relevance, look for postoperative infection predicted new reference index.Methods: Our hospital orthopedic fractures due ORIF surgery 30 cases, the third day after surgery to extract sodium citrate anticoagulant, natural erythrocyte rosette rate of tumor cells(NTERR), At the same time blood test erythrocyte sedimentation rate(ESR),c-reactive protein(CRP) and white blood cell count(routine blood WBC), Using SPSS11.5 software packages in the linear correlation analysis NTERR relevance to the rest of the all.Results: Four groups of data to detect all accord with normal distribution. NTERR andESR have linear negative correlation, the correlation coefficient is 0.805; NTERR and CRP have linear negative correlation, the correlation coefficient is 0.718; NTERR and WBC count with linear negative correlation, the correlation coefficient is 0.667.Conclusion: Orthopaedic surgery NTERR has correlation with the ESR and CRP and WBC, a linear negative correlation, erythrocyte immune function to reduce clew infection related index rise; Erythrocyte immune function was observed to reduce postoperative reference index can be used to supplement the predicted postoperative infection. |
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