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

Clinical value of combined detection of biomarkers urinary C-terminal telopeptide of type Ⅱcollagen, serum cartilage oligomerie matrix protein and serum chondroitin sulfate 846 in early diagnosis of osteoarthritis

目的评价联合检测尿C-末端Ⅱ型胶原(CTX-Ⅱ)、血清软骨寡聚基质蛋白(COMP)和硫酸软骨素846(CS-846)等生物学标志物在骨关节炎早期诊断中的价值。方法采用VAS评分法对患者疼痛程度进行评估后摄X线片,采用ELISA法检测骨关节炎患者及健康对照组血清中COMP、CS-846的浓度及尿液中CTX-Ⅱ浓度,并对上述指标进行相关性分析。结果骨关节炎组尿CTX-Ⅱ、血清COMP和CS-846含量均高于对照组,随着骨关节炎患者VAS评分及关节间隙狭窄程度的升高或加重,尿C-末端Ⅱ型胶原、血清COMP和CS-846水平逐渐升高。统计学分析结果显示,尚不能认为血清COMP水平与疼痛VAS评分之间有相关性,但其与关节间隙狭窄程度之间存在相关性;而血清CS-846水平及尿CTX-Ⅱ与疼痛VAS评分及关节间隙狭窄程度之间均有相关性。结论联合检测尿CTX-Ⅱ、血清COMP和CS-846等生物学标志物有望成为骨关节炎早期诊断的一种有效方法,但临床应用尚需要有更确切的循证医学证据。

Objective The aim of this study was to evaluate the clinical significance of combined measurement of biomarkers including urinary C-terminal telopeptide of type Ⅱcollagen, serum cartilage oligomerie matrix protein （COMP） and serum chondroitin sulfate 846 （CS-846） in the early diagnosis of osteoarthritis. Methods Patients diag-nosed with knee osteoarthritis by field epidemiology investigations were graded with the Visual Analogue Scale （VAS） and subject to X-ray. The concentrations of serum COMP and CS-846 and urinary C-terminal telopeptide of type Ⅱcollagen were detected by ELISA. The correlation between these biomarkers and imaging indexes and VAS scores were statistically analyzed. Results The levels of urinary C-terminal telopeptide of type Ⅱcollagen, serum COMP and CS-846 in the osteoarthritis group were significantly higher those in the control group. The levels of these biomarkers gradually increased along with the elevation or aggravation of VAS scores and joint space narrowing. It has been not confirmed that COMP level was correlated with VAS scores, whereas COMP concentration was correlated with joint space narrowing. Serum CS-846 and urinary C-terminal telopeptide of type Ⅱcollagen levels were correlated with VAS pain scores and the narrowing of joint space. Conclusion Taken together, combined detection of biomark-ers urinary C-terminal telopeptide of type Ⅱcollagen, serum COMP and serum CS-846 may prove a promising method in the early diagnosis of osteoarthritis. However, more evidence-based medicine proof is urgently needed in clinical application.