膝骨关节炎患者病情严重程度与尿CTX-Ⅱ及尿COMP的相关研究
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摘要
目的观察膝骨关节炎(KOA)患者尿Ⅱ型胶原C端肽(CTX-Ⅱ)及软骨寡聚基质蛋白(COMP)的表达变化,并探讨其与病情严重程度的相关性。方法选取2017年8月至2018年3月于南京医科大学附属明基医院被明确诊断为KOA的113例患者作为KOA组,Kellgren-Lawrence(K-L)分级:Ⅰ级27例,Ⅱ级34例,Ⅲ级27例,Ⅳ级25例。另外随机选取同期30名健康体检者作为对照组。通过酶联免疫吸附试验法检测所有受试者尿CTX-Ⅱ及COMP水平,并对检测结果进行分析、比较。结果 KOA组尿CTX-Ⅱ及COMP水平明显高于对照组(P <0. 05);KOA患者尿CTX-Ⅱ及COMP水平随K-L分级的增加而逐渐升高,且各K-L级别间尿CTX-Ⅱ及COMP水平比较差异有统计学意义(P <0. 05); KOA患者K-L分级与尿CTX-Ⅱ(r=0. 357,P=0. 002)及COMP(r=0. 206,P=0. 005)呈正相关。结论 KOA可引起尿CTX-Ⅱ及COMP水平升高,两者可作为KOA诊断及严重程度评估的参考标志物。
Objective To observe the expression of urinary collagen type Ⅱ C-telopeptide( CTX-Ⅱ) and cartilage oligomeric matrix protein( COMP) in patients with knee osteoarthritis( KOA),and explore their relevance to the severity of the disease. Methods A total of 113 patients with KOA diagnosed in the Affiliated Ben Q Hospital of Nanjing Medical University from Aug. 2017 to Mar. 2018 were included as a KOA group. Depending on the Kellgren-Lawrence( K-L)classification,they were classified: gradeⅠ27 cases,gradeⅡ34 cases,grade Ⅲ 27 cases,grade Ⅳ 25 cases. At the same time,30 healthy people during the same period were randomly chosen as a control group. The urinary CTX-Ⅱ and COMP in all subjects were detected by enzyme linked immunosorbent assay and the results were analyzed and compared. Results Levels of urinary CTX-Ⅱ and COMP in the KOA group were obviously higher than those in the control group( P < 0. 05). The levels of urinary CTX-Ⅱ and COMP in the KOA group increased gradually with the increase of K-L grade,with statistically significant difference( P < 0. 05). K-L grade in KOA patients was positively correlated with urinary CTX-Ⅱ( r = 0. 357,P =0. 002) and COMP( r = 0. 206,P = 0. 005). Conclusion KOA can cause elevated levels of urinary CTX-Ⅱ and COMP,which can both be used as reference markers for the diagnosis and severity assessment of KOA.
Objective To observe the expression of urinary collagen type Ⅱ C-telopeptide( CTX-Ⅱ) and cartilage oligomeric matrix protein( COMP) in patients with knee osteoarthritis( KOA),and explore their relevance to the severity of the disease. Methods A total of 113 patients with KOA diagnosed in the Affiliated Ben Q Hospital of Nanjing Medical University from Aug. 2017 to Mar. 2018 were included as a KOA group. Depending on the Kellgren-Lawrence( K-L)classification,they were classified: gradeⅠ27 cases,gradeⅡ34 cases,grade Ⅲ 27 cases,grade Ⅳ 25 cases. At the same time,30 healthy people during the same period were randomly chosen as a control group. The urinary CTX-Ⅱ and COMP in all subjects were detected by enzyme linked immunosorbent assay and the results were analyzed and compared. Results Levels of urinary CTX-Ⅱ and COMP in the KOA group were obviously higher than those in the control group( P < 0. 05). The levels of urinary CTX-Ⅱ and COMP in the KOA group increased gradually with the increase of K-L grade,with statistically significant difference( P < 0. 05). K-L grade in KOA patients was positively correlated with urinary CTX-Ⅱ( r = 0. 357,P =0. 002) and COMP( r = 0. 206,P = 0. 005). Conclusion KOA can cause elevated levels of urinary CTX-Ⅱ and COMP,which can both be used as reference markers for the diagnosis and severity assessment of KOA.
引文
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[24] Fife RS,Brandt KD. Cartilage matrix glycoprotein is present in serum in experimental canine osteoarthritis[J]. J Clin Invest,1989,84(5):1432-1439.
[25]黄阔,李光迪,刘玮玮,等.软骨寡聚基质蛋白在关节炎中的作用[J].现代生物医学进展,2015,15(24):4786-4789.
[2]张延辉,高春阳,李少华.骨性关节炎患者退变软骨及滑膜组织中细胞因子的表达[J].中国组织工程研究,2013,17(37):6671-6675.
[3]刘华,李化光.膝关节骨关节炎流行病学研究进展[J].中国矫形外科杂志,2013,21(5):482-485.
[4]朱振安.重视膝关节骨关节炎的早期防治[J].中国骨伤,2010,23(12):887-889.
[5]张军锋,宋玲花,董海原,等.联合检测尿C-末端Ⅱ型胶原血清软骨寡聚基质蛋白和硫酸软骨素846在骨关节炎早期诊断中的价值[J].中国药物与临床,2014,14(7):861-864.
[6]中华医学会骨科学分会.骨关节炎诊治指南(2007年版)[J/CD].中华关节外科杂志(电子版),2007,1(4):287-291.
[7] Kellgren JH,Lawrence JS. Radiological assessment of osteoarthrosis[J]. Ann Rheum Dis,1957,16(4):494-502.
[8] Cross M,Smith E,Hoy D,et al. The global burden of hip and knee osteoarthritis:Estimates from the global burden of disease2010 study[J]. Ann Rheum Dis,2014,73(7):1323-1330.
[9] Michael JW,Schluter-Brust KU,Eysel P. The epidemiology,etiology,diagnosis,and treatment of osteoarthritis of the knee[J]. Dtsch Arztebl Int,2010,107(9):152-162.
[10] Nguyen US,Zhang Y,Zhu Y,et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis[J]. Ann Intern Med,2011,155(11):725-732.
[11] Roos EM,Arden NK. Strategies for the prevention of knee osteoarthritis[J]. Nat Rev Rheumatol,2016,12(2):92-101.
[12] Goldring SR,Goldring MB. Changes in the osteochondral unit during osteoarthritis:Structure, function and cartilage-bone crosstalk[J]. Nat Rev Rheumatol,2016,12(11):632-644.
[13]金立昆,谢利民,李玉彬,等.膝骨关节炎临床症状与X线表现相关性研究[J].中国骨伤,2009,22(3):170-173.
[14]刘卉荣,王志芳,马蕾,等. X线、CT、MRI三种技术诊断退行性膝关节炎的临床价值[J].医学影像学杂志,2016,26(8):1549-1552.
[15]王学宗,高宁阳,刘婷,等.软骨标志物CTX-Ⅱ在骨关节炎中的应用[J].中国骨伤,2013,26(3):260-263.
[16]夏玲,王欢,窦晓丽,等.膝骨性关节炎的非手术治疗现状[J].中国老年学,2011,31(8):1491-1494.
[17] Lane NE,Brandt K,Hawker G,et al. OARSI-FDA initiative:Defining the disease state of osteoarthritis[J]. Osteoarthritis Cartilage,2011,19(5):478-482.
[18]朱瑜琪,王智耀,张帅,等.细胞因子与膝骨关节炎关节软骨损伤的修复[J].中国组织工程研究,2017,21(36):5873-5878.
[19] Kizawa H,Kou I,Iida A,et al. An aspartic acid repeat polymorphism in asporin inhibits chondrogenesis and increases susceptibility to osteoarthritis[J]. Nat Genet,2005,37(2):138-144.
[20] Herrero-Beaumont G,Roman-Blas JA. Osteoarthritis:Osteoporotic OA:A reasonable target for bone-acting agents[J]. Nat Rev Rheumatol,2013,9(8):448-450.
[21] Eyre DR,Apon S,Wu JJ,et al. Collagen typeⅨ:evidence for covalent linkages to typeⅡcollagen in cartilage[J]. Febs Lett,1987,220(2):337-341.
[22] Christgau S,Garnero P,Fledelius C,et al. Collagen typeⅡCtelopeptide fragments as an index of cartilage degradation[J].Bone,2001,29(3):209-215.
[23] Huebner JL,Williams JM,Deberg M,et al. Collagen fibril disruption occurs early in primary guinea pig knee osteoarthritis[J].Osteoarthr Cartilage,2010,18(3):397-405.
[24] Fife RS,Brandt KD. Cartilage matrix glycoprotein is present in serum in experimental canine osteoarthritis[J]. J Clin Invest,1989,84(5):1432-1439.
[25]黄阔,李光迪,刘玮玮,等.软骨寡聚基质蛋白在关节炎中的作用[J].现代生物医学进展,2015,15(24):4786-4789.