TMJ结构紊乱患者关节液纤维蛋白含量的测定及意义

The significance of fibrin in synovial fluid for patients with internal derangement of the temporomandibular joint

目的:测定颞下颌关节(temporomandibular joint,TMJ)结构紊乱(internal derangement,ID)患者关节液中纤维蛋白的含量,并探讨其意义。方法:选取2007年12月—2008年6月期间收治的TMJ疾病患者进行临床检查,在初步诊断为结构紊乱后进行MRI检查,以获取评价关节盘情况的影像学依据,并按照Wilkes-Bronstein分期标准进行分期,将处于Ⅱ～Ⅴ期的患者纳入治疗范围,进行关节镜下盘复位固定手术,在关节镜手术前采集关节液1mL,-40℃或-70℃冰箱低温保存。采用免疫荧光激光共聚焦显微镜半定量测定纤维蛋白的含量。按照ID分期、不同年龄段、男女分组及左右侧关节分组,应用SPSS16.0软件包对所得数据进行t检验,比较不同组别之间关节液的平均荧光强度的差异。结果:所有125侧关节液的免疫荧光强度平均为4.43±3.67(0～31.68)。ID各期关节液的平均荧光强度Ⅱ期为2.38±1.17,Ⅲ期为4.68±3.98,Ⅳ期为4.80±2.80,Ⅴ期为3.58±2.64,其中Ⅱ期与Ⅲ期(P=0.0065<0.05)、Ⅳ期(P=0.0207<0.05)之间有显著差异。男性患者关节液的荧光强度平均为4.05±2.70,女性患者关节液的荧光强度平均为5.57±4.71,男女之间有显著差异(P<0.05)。左侧TMJ关节液的平均荧光强度为4.37±3.04,右侧平均为5.97±5.20,两者有显著差异(P<0.05)。10～19岁为4.55±2.45,20～29岁为4.56±3.39,30～39岁为2.60±1.12,40岁以上为5.68±6.71,其中第1和第3组,第2和第3组及第3和第4组年龄段之间有显著差异。结论:关节液的平均荧光强度随着ID分期增高,呈现升高趋势,为IA形成假说提供了理论支持。

PURPOSE： To analyze the synovial fluid,and explore the significance of fibrin during the formation of intra-articular adhesion（IA）.METHODS：Arthroscopic disc repositioning and suturing was performed on patients with temporomandibular joint（TMJ） internal derangement（ID） ranging from stage Ⅱ to Ⅴ who visited the TMJ clinic at the Ninth People’s Hospital,Shanghai JiaoTong University School of Medicine,between Dec.27,2007 and Jun.16,2008.The patients’ ID stages were classified based on the criteria of Wilkes ＆ Bronstein’s classification.125 samples of synovial fluids were collected before arthroscopic surgery and stored in cold environment.According to the fluorescence intensity of each sample,and the immunofluorescence confocal laser microscopic semi-quantitative analysis was used to determinate the content of fibrin.Student’s t test was performed using SPSS16.0 software package,to compare the difference of the average fluorescence intensity of joint fluid in different groups（ID stage,different age,different sex and different joints）.RESULTS：There was statistically significant difference in the synovial fluid immune fluorescence intensity in different sex and age group.The average synovial fluid immune fluorescence intensity of all 125 samples was 4.43±3.67（0-31.68）.The average immune fluorescence intensity of each stage was stage Ⅱ： 2.38±1.17,stage Ⅲ： 4.68±3.98,stage Ⅳ： 4.80±2.80 and stage Ⅴ： 3.58±2.64.There was significant difference between the results of stage Ⅱ and stage Ⅲ（P=0.0065〈0.05）,and there was significant difference between the results of stage Ⅱ and stage Ⅳ（P=0.0207〈0.05）.The average immune fluorescence intensity of the male group was 4.05±2.70 and the female group was 5.57±4.71.There was significant difference between the results of male group and female group.The average immune fluorescence intensity of the synovial fluid of left TMJ was 4.37±3.04 and the right TMJ was 5.97±5.20.There was significant difference between the results of the left and right TMJ synovial fluids.The average immune fluorescence intensity of group 1 was 4.55±2.45,group 2 was 4.56±3.39,group 3 was 2.60±1.12 and group 4 was 5.68±6.71.There was significant difference between group 1 and group 3,group 2 and group 3,group 3 and group 4.CONCLUSION： The average intensity of TMJ increased with ID stage,which confirmed that fibrin in synovial fluid is one of the important protein factors during the formation of IA,and verified our hypothesis about the formation of IA.