[1]许东升,危一飞,蒋科卫,等.代谢综合征通过脂肪-炎症-凝血轴对全膝关节置换术围手术期的影响[J].陕西医学杂志,2025,54(12):1628-1634.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.007]
　XU Dongsheng,WEI Yifei,JIANG Kewei,et al.Impact of MetS on perioperative period of TKA through adipose-inflammation-coagulation axis[J].,2025,54(12):1628-1634.[doi:DOI:10.3969/j.issn.1000-7377.2025.12.007]
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代谢综合征通过脂肪-炎症-凝血轴对全膝关节置换术围手术期的影响

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年12期
页码:
1628-1634
栏目:
临床研究
出版日期:
2025-12-05

文章信息/Info

Title:
Impact of MetS on perioperative period of TKA through adipose-inflammation-coagulation axis
作者:
许东升; 危一飞; 蒋科卫; 郑仲洲; 张光熠
（中国中医科学院望京医院，北京 100102）
Author(s):
XU Dongsheng; WEI Yifei; JIANG Kewei; ZHENG Zhongzhou; ZHANG Guangyi
(Wangjing Hospital,China Academy of Chinese Medical Sciences,Beijing 100102,China)
关键词:
代谢综合征; 全膝关节置换术; 脂肪组织; 炎症反应; 凝血功能; 瘦素
Keywords:
Metabolic syndrome; Total knee arthroplasty; Adipose tissue; Inflammatory response; Coagulation function; Leptin
分类号:
R 589
DOI:
DOI:10.3969/j.issn.1000-7377.2025.12.007
文献标志码:
A
摘要:
目的：探究代谢综合征（MetS）通过脂肪组织介导的炎症-凝血级联反应对全膝关节置换术（TKA）围手术期的影响。方法：纳入122例单纯膝骨关节炎（KOA）患者（单纯KOA组）和57例合并MetS的KOA患者（MetS-KOA组），比较两组脂肪组织形态学、滑膜巨噬细胞极化、炎症指标、凝血功能及临床结局。结果：与单纯KOA组比较，MetS-KOA组髌下脂肪组织脂肪小叶直径增加，冠状结构（CLS）阳性率、脂肪组织瘦素水平升高（均P<0.05）；滑膜组织巨噬细胞M1/M2比值和肿瘤坏死因子-α（TNF-α）水平上升，血清白细胞介素-6（IL-6）水平上升（均P<0.05）；术后第1天D-二聚体水平升高，深静脉血栓发生率增加（均P<0.05）。相关性分析显示，瘦素水平与巨噬细胞M1极化呈正相关（r=0.318，P<0.05），术后第1天血清D-二聚体与滑膜组织TNF-α水平呈正相关（r=0.518，P<0.05）。结论：MetS通过脂肪小叶肥大及炎症浸润激活脂肪-滑膜炎症轴，并通过全身炎症反应加剧凝血紊乱，显著影响TKA围手术期预后。
Abstract:
Objective:To investigate the impact of metabolic syndrome (MetS) on the perioperative period of total knee arthroplasty (TKA) through the adipose tissue-mediated inflammation-coagulation cascade reaction.Methods：A total of 122 patients with simple knee osteoarthritis (KOA) (simple KOA group) and 57 KOA patients with MetS (MetS-KOA group) were enrolled.The differences in adipose tissue morphology,synovial macrophage polarization,inflammatory indicators,coagulation function,and clinical outcomes were compared and analyzed between the two groups.Results:Compared with the simple KOA group,the diameter of infrapatellar adipose tissue lobules in the MetS-KOA group increased,the positive rate of crown-like structures (CLS) and the leptin level in adipose tissue increased (all P<0.05);the ratio of M1/M2 macrophages and the level of tumor necrosis factor-α (TNF-α) in synovial tissue increased,while the level of serum interleukin-6 (IL-6) also rose (all P<0.05);on the first day after surgery,the D-dimer level and the incidence of venous thrombosis significantly increased (all P<0.05).Correlation analysis showed that leptin level was positively correlated with M1 polarization of macrophages (r=0.318,P<0.05),and serum D-dimer level on the first postoperative day was positively correlated with synovial TNF-α level (r=0.518,P<0.05).Conclusion:MetS activates the adipose-synovium inflammation axis through adipose lobule hypertrophy and inflammatory infiltration,and exacerbates coagulation disorders through systemic inflammatory responses,significantly affecting the perioperative prognosis of TKA.

参考文献/References:

[1]SMITH A,JOHNSON B,WILLIAMS C,et al.Perioperative outcomes of total knee arthroplasty in patients with metabolic syndrome[J].J Arthroplasty,2020,35(6):1623-1628.
[2]GARCIA D,MARTINEZ A,LOPEZ M,et al.Cytokine profiling in MetS patients undergoing TKA[J].Osteoarthritis Cartilage,2024,32(1):45-55.
[3]LI Y,ZHANG L,WANG H,et al.Leptin-induced M1 macrophage polarization in obesity-related osteoarthritis[J].Arthritis Res Ther,2021,23(1):156.
[4]中华医学会糖尿病学分会.中国糖尿病防治指南(2024版)[J].中华糖尿病杂志,2025,17(1):16-139.
[5]樊子娟,王桂杉,李川,等.《中国骨关节炎诊疗指南（2021 年版）》解读和评价 [J].中国循证医学杂志,2022,22(6):621-627.
[6]中国骨科大手术静脉血栓栓塞症预防指南[C]//中国康复医学会老年康复专业委员会.中国康复医学会第七次全国老年医学与康复学术大会资料汇编.中华医学会骨科学分会,2012:179-182.
[7]LAVAND’HOMME P M,KEHLET H,RAWAL N,et al.Pain management after total knee arthroplasty:Procedure specific postoperative pain management recommendations[J].Eur J Anaesthesiol,2022,39(9):743-757.
[8]徐丽丽,刘序强.全膝关节置换术后膝关节功能加速康复专家共识[J].山东大学学报(医学版),2024,62(10):48-61.
[9]康焱,周宗科,杨惠林,等.中国骨科手术加速康复切口管理指南[J].中华骨与关节外科杂志,2018,11(1):3-10.
[10]潘海燕,马磊,苏健,等.膝关节置换术后肺栓塞发生的相关危险因素研究 [J].实用临床医药杂志,2016,20(12):88-91.
[11]FAVERO M,EL-HADI H,BELLUZZI E,et al.Infrapatellar fat pad features in osteoarthritis:A histopathological and molecular study[J].Rheumatology (Oxford),2017,56(10):1784-1793.
[12]CHANG M C,ESLAMI Z,ENNIS M,et al.Crown-like structures in breast adipose tissue of breast cancer patients:Associations with CD68 expression,obesity,metabolic factors and prognosis[J].NPJ Breast Cancer,2021,7(1):97.
[13]HEIDARI B.Knee osteoarthritis prevalence,risk factors,pathogenesis and features:PartⅠ[J].Caspian J Intern Med,2011,2(2):205-212.
[14]MENARIM B C,GILLIS K H,OLIVER A,et al.Macrophage activation in the synovium of healthy and osteoarthritic equine joints[J].Front Vet Sci,2020,7:568756.
[15]BARROS M H,HAUCK F,DREYER J H,et al.Macrophage polarisation:An immunohistochemical approach for identifying M1 and M2 macrophages[J].PLoS One,2013,8(11):e80908.
[16]王正,刘安平,梁文武,等.半月板成形术配合中药内服治疗退行性半月板损伤近期疗效观察[J].安徽中医药大学学报,2020,39(5):8-11.
[17]XU L,ZHAO Y,ZHOU J,et al.CLS density correlates with synovitis severity in OA[J].Arthritis Rheumatol,2023,75(8):1320-1330.
[18]KWON J Y,PARK S,LEE J,et al.Leptin-induced synovial macrophage polarization via JAK/STAT pathway contributes to obesity-associated osteoarthritis[J].Arthritis Rheumatol,2023,75(7):1152-1163.
[19]LPEZ J A,GARCIA R,MARTINEZ S,et al.TNF-α promotes tissue factor expression via NF-κB-dependent epigenetic modifications in human endothelial cells[J].Blood,2023,141(8):876-889.
[20]黄玲,傅德杰,邓姝.全膝关节置换术后深静脉血栓形成机制、危险因素及预防研究进展[J].陕西医学杂志,2024,53(3):428-432.
[21]WANG Q,ZHANG Y,LIU H,et al.Thrombomodulin suppression by TNF-α in human endothelial cells[J].Thromb Haemost,2024,124(3):321-333.
[22]POTJE S R,SCHMIDT T,KRAMER C,et al.Insulin resistance promotes endothelial procoagulant activity by reducing nitric oxide bioavailability[J].Diabetes,2023,72(6):789-801.
[23]王志远,马建兵,魏威,等.加速康复外科干预预防中老年全膝关节置换术后 DVT 形成的效果研究 [J].陕西医学杂志,2018,47(8):1043-1046.
[24]张晨,宋国瑞,刘子歌,等.低分子肝素与利伐沙班预防全膝关节置换术后静脉血栓成形的疗效及安全性对比分析[J].陕西医学杂志,2020,49(9):1153-1156.
[25]EUROPEAN CONSORTIUM ON METABOLIC SURGERY.Consensus statement on perioperative anticoagulation management in metabolic syndrome patients undergoing major orthopaedic surgery[J].Thromb Res,2023,231:109-118.

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备注/Memo

备注/Memo:
国家自然科学基金青年科学基金资助项目（82305277）
更新日期/Last Update: 2025-12-05