关节液中TNF-α、IL-1、MMPS水平对膝骨性关节炎患者的预后的评估价值

Value of TNF-α,IL-1 and MMPS Levels in the Evaluation of Prognosis of Patients with Knee Osteoarthritis

目的：探讨关节液中肿瘤坏死因子（TNF-α）、白介素-1（IL-1）、基质金属蛋白酶（MMPS）水平与膝骨性关节炎患者预后的关系及评估价值。方法：选取2012年1月-2015年2月本院收治的经关节镜检查确诊为膝骨性关节炎患者80例作为研究对象,软骨的病变程度为Ⅰ～Ⅳ度,经关节镜下清理术治疗后再给予玻璃酸钠和双醋瑞因治疗,根据Shahariarre评分标准将患者分为预后良好组和预后不良组,采用ELISA方法检测患者治疗前后TNF-α、IL-1、MMP-3及MMP-9的含量,并作其与膝骨性关节炎病变程度Spearman相关分析,采用ROC曲线对膝骨性关节炎患者的TNF-α、IL-1、MMP-3、MMP-9的预后评估价值进行评价。结果：治疗前TNF-α、IL-1、MMP-3、MMP-9的含量与其病变的严重程度呈正相关（r=0.820、0.850、0.802、0.638,P〈0.01）;预后良好组TNF-α、IL-1、MMP-3及MMP-9含量明显低于预后不良组,比较差异均有统计学意义（P〈0.01）;TNF-α、IL-1、MMP-3及MMP-9含量的ROC曲线下面积分别为0.880、0.895、0.752、0.720。IL-1的敏感度为94.00%,特异度为64.00%;TNF-α的敏感度为87.00%,特异度为56.00%;MMP-3的敏感度为79.00%,特异度为42.00%;MMP-9的敏感度为70.00%,特异度为38.00%。结论：IL-1对膝骨性关节炎患者的影响是全方面的,能增强MMP-3和MMP-9对患者软骨的降解和破坏,TNF-α能通过降低软骨细胞的合成,加速软骨的降解,且TNF-α、IL-1、MMP-3、MMP-9的含量与患者的病变程度呈正相关,对患者的的预后评价有一定的评估价值。

Objective：To investigate the relationship between TNF-α,IL-1,MMPs levels and prognosis evaluation value in patients with knee osteoarthritis.Method：From January 2012 to February 2015,80 cases of knee osteoarthritis identified by arthroscopy in our hospital were selected as the research objects,the degree of cartilage lesions including Ⅰ-Ⅳ degree,they were given sodium hyaluronate and diacerein treated after arthroscopic debridement,patients were divided into good prognosis group and poor prognosis group according to the shahariarre scoring criteria,the content of TNF-α,IL-1,MMP-3 and MMP-9 before and after treatment were detected by ELISA method and Spearman correlation analysis were used to detect degree of pathological changes of knee osteoarthritis,the prognostic value of TNF-α,IL-1,MMP-9 and MMP-3 in patients with knee osteoarthritis were evaluated by ROC curve.Result：The content of TNF-α,IL-1,MMP-3 and MMP-9 before treatment was positively correlated with the severity of the lesion（r=0.820,0.850,0.802,0.638,P〈0.01）.TNF-α,IL-1,MMP-3 and MMP-9 levels of good prognosis group were significantly lower than the poor prognosis group,the differences were statistically significant（P〈0.01）.TNF-α,IL-1,MMP-3 and MMP-9 content of the area under the ROC curve were respectively 0.880,0.895,0.752 and 0.720.IL-1 sensitivity was 94.00% and specificity was 64.00%.TNF-α sensitivity was 87.00% and specificity was 56.00%.MMP-3 sensitivity was 79.00% and specificity was 42.00%.MMP-9 sensitivity was 70.00% and specificity was 38.00%.Conclusion：The effect of IL-1 on knee osteoarthritis is the whole,can enhance the degradation and destruction of cartilage in patients with MMP-3 and MMP-9.TNF-α can reduce the synthesis of cartilage cells and accelerate the degradation of cartilage,the content of TNF-α,IL-1,MMP-3 and MMP-9 are positively correlated with the extent of the lesion,have a certain value of assessment for patients with prognosis evaluation.