The Effects Study Of The Role Of Human β-Defensin 3 In Modulation Of Immunity And Inflammatory Response After Knee Replacement

Background:Total knee arthroplasty(TKA),as an effective therapy for end-stage and refractory knee joint diseases,is widely accepted by doctors and patients.However,widely-reported complications represented by prosthesis-related infections both reduce the significance of the treatment of patients to some extent and puzzle medical practitioners at home and abroad.Human beta defensin 3(HBD-3)is regarded as a bacteriostat or bactericide with a wide antibacterial spectrum,rapid action,stable property and immunomodulatory effects,but its value in post-TKA T-lymphocyte immunity and its effects on prosthesis-related infections are unknown yet.Objective:To investigate the value of HBD-3 in the regulation of the immunity andinflammatory responses of T-lymphocytes after TKA and its effects on prosthesis-related infections,and to deepen the understanding of HBD-3 and provide a theoretical basis for prophylaxis of prosthesis-related infections.Methods:From January 2014 to June 2015,64 patients who were to undergo TKA were divided into the observation group(n = 32)and the control group(n = 32)according to therandom principle.After perfection of preoperative preparation on admission,each TKA was done by the same senior attending physician.For the observation group,50μg/5 ml of HBD-3 was injected intra-articularly after intraoperative arthroplasty and before incision closure;the same dose of normal saline as placebo was administered into the control group.Standardized treatment was provided postoperatively.After intervention,percentages of helper T cell 1(Thl)and helper T cell 2(Th2)in peripheral blood were assayed by flow cytometry.Levels of interleukin-2(IL-2),interleukin-10(IL-10),tumor necrosis factor-a(TNF-a),toll like receptor-4(TLR-4),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and procalcitonin(PCT)for peripheral blood were assayed by ELISA.The activity of alkaline phosphatase(ALP)was assayed by 2-amino-2-methyl-l-propanol(AMP).For both groups,baseline data(including age,preoperative HSS score,range of motion(ROM),gender,amount of arthroplasties,and primary diseases),and differences in levels of Th1,Th2,Th1/Th2,IL-2,IL-10,TNF-α,TLR-4,ALP,ESR,CRP and PCT,and post-TKA prosthesis-related infection rate were recorded and analyzed by SPSS 20.0 software package.Results:(i)For both groups,baseline data including age,preoperative HSS score,ROM,gender,amount of arthroplasties,and primary diseaseswere well-balanced(P>0.05)and comparable.(ⅱ)Levels of Thl and Thl/Th2 increased for the observation group compared with the control group[(32.5±6.7)%vs.(13.6±5.2)%,(5.3±1.4)%vs.(0.6d±0.2)%,respectively;t=8.527 and 12.534,respectively;all P<0.05].The level of Th2 decreased for the observation group compared with the control group[(8.7±2.0)%vs.(24.6±5.3)%;t=9.413,P<0.05].(iii)Levels of IL-2 and TNF-aincreased for the observation group compared with the control group[(213.5±52.1)pg/ml vs.(140.7±43.6)pg/ml,(156.3±35.5)pg/ml vs.(114.7±32.6)pg/ml,respectively;t= 7.628 and 7.306,respectively;all P<0.05].The level of IL-10 decreased for the observation group compared with the control group[(46.9±21.4)pg/ml vs.(75.2±23.8)pg/ml,t=7.420,P<0.05].(iv)Levels of TLR-4,and ALP significantly increased for the observation group compared with the control group[(15.6±4.2)ng/ml vs.(10.2±4.0)ng/ml,(165.9±54.6)U/L vs.(123.8±48.9)U/L,respectively;t= 6.968 and 7.125,respectively;all P<0.05],but no significant differences were noted in levels of ESR,CRP and PCT between both groups(P>0.05).(v)No prosthesis-related infection was noted in either group during the study period.Conclusion:HBD-3 can regulate the immunity and inflammatory responses of T-lymphocytes after TKA,significantly increase levels ofTh1、IL-2、TLR-4、NF-αand ALP in the body,enhance the body immunity,and possibly play an important role in prevention against prosthesis-related infections.