Correlation Between Blood Glucose Level And Serum SICAM-1,IL-6,CRP And Postoperative VAS And HSS Scores In Patients With Diabetes Total Knee Arthroplasty

Objective:To investigate the relationship between blood glucose levels and serum sICAM-1,IL-6,CRP and postoperative VAS and HSS scores in patients with diabetic total knee arthroplasty.Methods:The study screened from January 2017 to March 2018,in the Department of Orthopaedics,Shanghai Ruijin Hospital,Gubei Branch,unilateral total knee arthroplasty for the knee osteoarthritis patients,a total of 76 patients,aged 54-88 years.Among them,20 males and 56 females,35 of whom were in the diabetes group and 41 in the non-diabetic group.6ml elbow venous blood(fasting 8?12h)was taken separately in the preoperative and 1st day,3rd day,7th day and 1 month after total knee arthroplasty surgery.3ml is used to measure FBG and CRP,HbAlc.The other 3 ml was placed at room temperature for 2 hours,centrifuged for 20 minutes,and the supernatant was taken and stored in a-80? low temperature refrigerator for use.Avoid repeated freezing and thawing.sICAM-1 and IL-6 were determined by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).The VAS and HSS scores were recorded before and 1 month after surgery.And then the trends and correlations of the indicators in the diabetic and non-diabetic groups were analyzed.Results:1.Compared with the non-diabetic group,preoperative blood glucose,sICAM-1,VAS scores,the 1st postoperative day's blood glucose,CRP,IL-6,sICAM-1,the 3rd postoperative day's blood glucose,CRP,IL-6,sICAM-1,the 7th postoperative day's CRP,sICAM-1,IL-6 and the 1st months' sICAM-1 are all increased in the diabetic group(P<0.01);preoperative HbAlc was increased(P<0.05)with statistical difference.Compared with the non-diabetic group,the HSS score decreased in the diabetic group 1 month after operation(P<0.01);the VAS score decreased in the diabetic group 1 month after operation(P<0.05),with statistical difference.Compared with the preoperative condition of the diabetic group,the CRP at the 1st day,3rd day,and 7th day after surgery,the IL-6 at 1st day,3rd day after surgery,and the HSS score at 1 month after surgery were increased(P<0.01),the sICAM-1 of the 1st day after operation and the VAS score at the 1st month after operation were decreased in the diabetic group(P<0.01),with statistical difference.2.The preoperative FBG in the diabetic group was positively correlated with CRP on the first day after operation,sICAM-1 before and 1 month after operation(all P<0.01),and positively correlated with IL-6 on the first day after operation(P<0.05).The first day after operation FBG level in the diabetic group was positively correlated with CRP and IL-6 on the 1st and 3rd day after operation,and sICAM-1 before and 1 month after operation(all P<0.01);and got a positive correlation with the 7th day after operation CRP and IL-6 in the first month after operation(all P<0.05).The 3rd day after operation FBG level in the diabetic group was positively correlated with CRP on the 1st and 3rd day after operation and sICAM-1 on the 1 month after operation(P<0.01);and also was positively correlated with IL-6 on the 3rd day after operation(P<0.05).There was a positive correlation between preoperative HbA1c and CRP,IL-6 on the 1st day after operation and preoperative sICAM-1 in the diabetic group(P<0.01);and was a positive correlation between preoperative HbA1c and the 7th postoperative day CRP and sICAM-1 on the 1 month after operation.(P<0.05).The the 1st postoperative day FBG and preoperative HbAlc in the diabetic group were negatively correlated with the sICAM-1 on the 1st postoperative day(P<0.01).The FBG on the 3rd day after operation was negatively correlated with the sICAM-1 on the 1st postoperative day(P<0.05).3.The influencing factors of VAS score in the diabetic group 1 month after operation were preoperative FBG,preoperative HbA1c,FBG on the 1st day after operation,IL-6 on the 7trh day after surgery,CRP on the 1st postoperative day,CRP on the 3rd day after surgery,CRP on the 7th day after surgery,and sICAM-1 on the 1st day after surgery.Multivariate stepwise regression analysis showed preoperative FBG,IL-6 on the 7th day after surgery,CRP on the 1st postoperative day,CRP on the 3rd day after surgery,and sICAM-1 on the 1st day after surgery had the greatest impact on VAS scores at 1 month postoperatively.4.The factors affecting the HSS score at 1 month after operation in the diabetic group included blood glucose on the first day after surgery,IL-6 on the first day after surgery,sICAM-1 on the first postoperative day,preoperative IL-6,and preoperative blood glucose.The results of the multivariate stepwise regression analysis showed that the blood glucose on the first day after operation,IL-6 on the first day after surgery,sICAM-1 on the first postoperative day,and preoperative IL-6 had the greatest influence on the HSS score in the first month after operation.Conclusion:1.Perioperative FBG in patients with diabetic total knee arthroplasty affects the levels in CRP,sICAM-1 and IL-6.While the levels of CRP,sICAM-1 and IL-6 were significantly associated with the VAS and HSS scores at 1 month after operation,which may affect postoperative outcomes.2.Preoperative HbAlc level affects the levels of CRP,IL-6 and sICAM-1 in patients with diabetes total knee arthroplasty,which affects the postoperative VAS pain score,but does not see the effect on knee HSS score.Preoperative HbAlc level may be involved in affecting postoperative outcomes.