The Expression Of Bradykinin And Its Receptors In Patients With Advanced Knee Disease And The Relationship With Knee Joint Pain In The Peiroperative Peroid

Background:For patients with advanced knee joint disease, knee joint pain in theperioperative peroid seriously affect the patients postoperative functional exercise andrehabilitation.Mechanisms of its mechanism of knee joint pain and analgesictreatment has attaracted serious concern.The algogenic and proinflammatory effectsof bradykinin are consequent of activation of the two bradykinin receptors,mechanisms of which have been confirmed by vitro experiments.It is unclear that therelationship between bradykinin and its receptors and knee joint pain in patiens withadvanced knee disease,as well as clarify the changes in blood and knee joint fluidbradykinin concentrations and its relationship with knee joint pain in the perioperativeperoid. To provide a reference for perioperative knee pain treatment and analgesicdrug development of patients with advanced disease.Objective:To study the changes of bradykinin concentration in blood and knee jointfluid and expression of bradykinin receptrors in knees of patients who underwent totalknee arthroplasty for advanced knee joint disease, as well as the relationship with theknee joint pain in the perioperative peroid.Methods:Among the patients who underwent primary total knee arthroplasty betweenoctober2011and october2012in Chinese PLA General Hospital, after inclusion andexclusion criteria screening, gaining experimental group which includes50peoplewith50knees. three patients with normal knees who underwent amputation fortrauma was accepted in control group.Use visual analogue scale to measurepreoperative knee joint pain under the normal life status.Using enzyme-linkedimmunosorbent experiment measures bradykinin concentrations in the blood and kneejoint fluid respectively in the preoperative and postoperative3,12,24, and36hours. Synovium of knee joint obtained in the regular primary total knee arthroplasty wasstained with hematoxylin and eosin,receptors of bradykinin were stained withimmunohistochemistry to measure synovial tissue bradykinin receptor expressionlevels qualitatively and quantitatively.(1) Comparison of bradykinin receptor B1, B2expression differences between theexperimental and control groups, and its expression levels in the experimental group.(2) Comparison of B1and B2receptor expression differences between OA subgroupand RA subgroup and its expression levels in each subgroup.(3) To study bradykinin concentration in knee joint fluid and expression of bradykininreceptrors of knees synovial tissue, as well as the relationship with the knee joint painin the perioperative peroid.(4) Evaluate the bradykinin concentration changes of experimental group in the bloodand knee joint fluid in the preoperative and postoperative3,12,24, and36hours,aswell as its relationship with knee painResults：(1) B1, B2receptor in knee joint synovium were higher in experimental group thancontrol group, the expression level of B1receptor was higher than B2receptor inexperimental group,the differences were all statistically significant.(2) The expression levels of B1receptor and B2receptor were higher in RA subgroupthan OA subgroup. The expression level of B1receptor was higher than B2receptorin both OA and RA subgroup.(3) There was moderate positive correlation between concentration of bradykinin inperioperative synovial fluid and knee joint pain.The expression level differences ofB1receptor and B2receptor between3grade VAS and2grade VAS werestatistically significant.(4) After primary total knee arthroplasty,bradykinin concentration in knee joint wassignificantly increased, after12hours reached its peak, then decreased.Conclusion：(1) The increase of preoperative bradykinin concentration in the knee joint in patientswith advanced knee disease and high expression of the knee synovial tissue bradykinin receptors is one of the important causes of perioperative pain in the knee.(2) The expression level of B1receptor was higher than B2receptor in both twosubgroup.(3) For patients with RA or OA, there was moderate positive correlation betweenbradykinin concentration in synovial fluid and joint pain. The expression ofbradykinin receptors in knee joint varies from pain score to pain score.(4) After primary total knee arthroplasty, bradykinin concentration in knee joint wassignificantly increased, then decreased after12hours.