| 瘀血阻滞型膝骨性关节炎与其关节镜下病理改变及细胞因子相关性 |
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Received:July 21, 2010
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| 期刊信息：《中国骨伤》2010年23卷，第12期，第890-893页 |
| DOI：10.3969/j.issn.1003-0034.2010.12.002 |
| 基金项目:福建省教育厅科技项目(编号：JB09157) |
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目的：探讨瘀血阻滞型膝骨性关节炎与细胞因子及关节镜下病理改变之间的相关性，为中医临床诊治提供客观量化指标。
方法：2009年2月至2010年3月膝骨性关节炎住院患者90例，男17例，女73例；年龄40～70岁，平均57.2岁；病程1个月～10年，平均3.4年；左膝31例，右膝59例。对纳入病例行中医辨证，选择瘀血阻滞型患者，术前均有膝关节固定刺痛、晨僵，大部分有交锁现象，均无关节肿胀。术前采集关节液，ELISA法测定细胞因子白细胞介素-1β(IL-1β)、转化生长因子-β1(TGF-β1)的含量，同时在关节镜下观察关节内病理改变。综合以上资料探讨瘀血阻滞型膝骨性关节炎病变程度，同时对不同类型关节镜下病理改变与细胞因子水平进行相关性分析。
结果：关节液IL-1β和TGF-β1水平分别为(28.18±5.57) pg/ml和(51.69±6.56) pg/ml.Ⅲ～Ⅳ度软骨退变组IL-1β水平为(30.65±3.48) pg/ml,高于Ⅰ～Ⅱ度软骨退变组的(20.55±3.50) pg/ml;Ⅰ～Ⅱ度软骨退变组TGF-β1水平为(58.18±3.98) pg/ml,高于Ⅲ～Ⅳ度软骨退变组的(49.59±5.83) pg/ml,差异有统计学意义(P<0.01);IL-1β与软骨退变呈正相关，r=0.744 ,TGF-β1与软骨退变呈负相关，r=-0.563.Ⅱ～Ⅲ度滑膜增生组IL-1β水平为(33.48±2.95) pg/ml,高于Ⅰ度滑膜增生组的(25.40±4.50) pg/ml,差异有统计学意义(P<0.01);IL-1β与滑膜增生呈正相关，r=0.801.Ⅰ级骨赘增生组IL-1β水平为(34.18±2.69) pg/ml,高于0级骨赘增生组的(25.74±4.48) pg/ml;0级骨赘增生组TGF-β1水平为(53.11±6.78) pg/ml,高于Ⅰ级骨赘增生组的(48.21±4.47) pg/ml,差异有统计学意义(P<0.01);IL-1β与骨赘增生呈正相关，r=0.762;TGF-β1与骨赘增生呈负相关，r=-0.340.
结论：瘀血阻滞型膝骨性关节炎患者存在关节软骨退变、滑膜增生等病理改变，IL-1β水平对软骨退变、滑膜增生和骨赘增生程度的估计有重要参考价值。 |
| [关键词]:骨关节炎,膝 关节镜检查 白细胞介素1 转化生长因子β 血瘀 辨证分型 |
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| Study on correlation between the pathological changes under arthroscopy and the cytokine levels in the knee osteoarthritis of the Blood Stasis type |
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Abstract:
Objective: To explore the correlation between cytokine levels and the pathological changes under arthroscopy in knee osteoarthritis of Blood Stasis type.
Methods: From 2009.2 to 2010.3,90 patients with knee osteoarthritis were reviewed. Among the patients,17 patients were male and 73 patients were female,ranging in age from 40 to 70 years,averaged 57.2 years,the duration of the disease ranged from 1 month to 10 years,with a mean of 3.4 years. Thirty-one patients had osteoarthritis in left knee,and 59 patients in right knee. The patients had the syndrome of blood stasis. All the patients had pain and morning stiffness;most patients had joint interlocking;and all the patients didn't have joint swelling. The synovial fluid was collected before surgery,and ELISA was used to detect the contents of interleukin-1β and transforming growth factor-β1. At the same time,the pathological changes of the joint were observed under the arthroscopy. Based on the above datum analysis,the severity of knee osteoarthritis of blood stasis type was studied,and the correlation between different types of pathological changes under arthroscopy and cytokine levels was analyzed.
Results: The contents of IL-1β and TGF-β1 in synovial fluid were(28.18±5.57) pg/ml and(51.69±6.56) pg/ml respectively. The level of IL-1β of gradeⅢ～Ⅳcartilage degeneration was(30.65±3.48)pg/ml,which was significantly higher than(20.55±3.50) pg/ml of gradeⅠ～Ⅱcartilage degeneration group;the level of TGF-β1 of gradeⅠ～Ⅱcartilage degeneration was(58.18±3.98) pg/ml,which was significantly higher than(49.59±5.83) pg/ml of gradeⅢ～Ⅳcartilage degeneration group. IL-1β and cartilage degeneration was positively correlated,the correlation coefficient was 0.744;TGF-β1 and cartilage degeneration was negatively correlated,the correlation coefficient was -0.563. The level of IL-1β of gradeⅡ～Ⅲsynovial hyperplasia was(33.48±2.95) pg/ml,which was significantly higher than(25.40±4.50) pg/ml of gradeⅠsynovial hyperplasia group;IL-1β was positively correlated with synovial hyperplasia,the correlation coefficient was 0.801. The levels of IL-1β of gradeⅠosteophyte formation was(34.18±2.69) pg/ml,which was significantly higher than(25.74±4.48) pg/ml of grade 0 osteophyte formation group;the level of TGF-β1 of grade 0 osteophyte formation was(53.11±6.78) pg/ml,which was higher than(48.21±4.47) pg/ml of gradeⅠosteophyte formation group. IL-1β was positively correlated with osteophyte formation,the correlation coefficient was 0.762;TGF-β1 was negatively correlated with osteophyte formation,the correlation coefficient was - 0.340.
Conclusion: All the patients with knee osteoarthritis identified as blood stasis syndrome have pathological changes such as articular cartilage degeneration and synovial hyperplasia. The level of IL-1β has important reference value to estimate the severity of cartilage degeneration,synovial hyperplasia and osteophyte proliferation. |
| KEYWORDS:Osteoarthritis, knee Arthroscopy Interleukin-1 Transforming growth factor beta Blood Stasis Syndrome differ classification |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 修忠标,陈文通,孙克民.瘀血阻滞型膝骨性关节炎与其关节镜下病理改变及细胞因子相关性[J].中国骨伤,2010,23(12):890~893 |
| 英文格式: | XIU Zhong-biao,CHEN Wen-tong,SUN Ke-min.Study on correlation between the pathological changes under arthroscopy and the cytokine levels in the knee osteoarthritis of the Blood Stasis type[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(12):890~893 |
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