膝关节炎患者中医证素及其血清DNMT1和EZH2变化与临床意义

Traditional Chinese Medicine syndrome elements and changes in serum DNMT1 and EZH2 in patients with knee osteoarthritis and their clinical significance

目的探讨膝关节炎(KOA)患者中医证素与血清DNA甲基转移酶1(DNMT1)、zeste基因增强子同源物2(EZH2)水平以及KOA病情的关系。方法选择门诊收治的100例KOA患者,依据《证素辨证学》结合中医四诊资料提取患者中医证素,采用视觉模拟量表(VAS)评价患者膝关节疼痛程度,Kazam超声评级标准评价患者软骨损伤程度,检测血清DNMT1 mRNA、EZH2水平。根据VAS评分将患者分为VAS≥4分组(56例)和VAS<4分组(44例),根据Kazam超声评级将患者Kazam超声评级≥Ⅲ级组(48例)和Kazam超声评级<Ⅲ级组(52例)。二元logistic回归分析影响KOA患者疼痛和软骨损伤程度的因素。结果KOA患者病位证素以肾、肝、脾、胃为主(分别占95.00%、82.00%、77.00%、72.00%),实证证素以瘀、寒、风、湿为主(分别占96.00%、92.00%、72.00%、65.00%),虚证证素以阳虚为主(占68.00%)。VAS评分≥4分组、Kazam超声评级≥Ⅲ级组肾、肝、脾、胃、瘀、寒、风、湿、阳虚比例以及血清DNMT1 mRNA表达、EZH2水平高于VAS评分<4分组、Kazam超声评级<Ⅲ级组(P<0.05)。重度KOA、肝、肾、瘀、寒、高DNMT1 mRNA、高EZH2是影响KOA患者疼痛程度的危险因素(P<0.05)。重度KOA、肾、瘀、高DNMT1 mRNA、高EZH2是影响KOA患者软骨损伤程度的危险因素(P<0.05)。结论KOA病位证素以肾为主,病性证素以血瘀为主,KOA患者血清DNMT1 mRNA表达、EZH2水平均增高,中医证素和血清DNMT1 mRNA、EZH2可为KOA疼痛程度和软骨损伤评估提供查考。

Objective To investigate the correlations between traditional Chinese medicine syndrome elements and serum DNA methyltransferase 1(DNMT1),enhancer of zeste homolog 2(EZH2)levels and the severity of knee ar-thritis(KOA).Methods A total of 100 patients with KOA were selected.TCM syndrome elements were extracted ac-cording to Syndrome differentiation and TCM four diagnosis data.Visual analogue scale(VAS)was used to evaluate the knee pain of patients,and Kazam ultrasound rating standard was used to evaluate the cartilage injury degree.The levels of DNMT1 mRNA and EZH2 in serum were assessed.According to the VAS score,the patients were divided into VAS≥4 group(56 cases)and VAS<4 group(44 cases).According to the Kazam ultrasound rating,the patients were divided into Kazam ultrasound rating≥II group(48 cases)and Kazam ultrasound rating<II group(52 cases).Binary logistic regres-sion analysis was used to analyze the influencing factors of pain and cartilage injury in patients with KOA.Results Among patients with knee osteoarthritis(KOA),the predominant Traditional Chinese Medicine(TCM)syndrome elements for disease location were kidney,liver,and spleen-stomach;for excess syndrome,they were blood stasis,cold,wind,and dampness;and for deficiency syndrome,it was primarily yang deficiency.The proportions of kidney,liver,spleen-stom-ach,blood stasis,cold,wind,dampness,and yang deficiency,as well as the levels of serum DNMT1 mRNA and EZH2,were higher in the group with VAS scores≥4 and Kazam ultrasound grades≥II compared to the group with VAS scores<4 and Kazam ultrasound grades<II(P<0.05).Severe KOA,liver syndrome,kidney syndrome,blood stasis,cold syndrome,high DNMT1 mRNA,and high EZH2 were identified as risk factors affecting the degree of pain in KOA pa-tients(P<0.05).Severe KOA,kidney syndrome,blood stasis,high DNMT1 mRNA,and high EZH2 were identified as risk factors affecting the degree of cartilage damage in KOA patients(P<0.05).ConclusionKidney syndromewasthe main TCM syndrome element associated with KOA,while blood stasis was the main pathological syndrome element.The expression of serum DNMTI mRNA and EZH2 levels were elevated in KOA patients.TCM syndrome elements and serum DNMT1 mRNA and EZH2 levels could be useful for assessing the degree of pain and cartilage damage in KOA.