关节腔注射富血小板血浆对膝骨关节炎患者关节液及血浆中IL-17的影响

Effect of intra-articular injection of platelet-rich plasma on interleukin-17 expression in synovial fluid and venous plasma of knee osteoarthritis patients

目的探讨关节腔注射富血小板血浆(platelet-rich plasma,PRP)治疗后,膝骨关节炎(osteoarthritis,OA)患者血浆和关节滑液中IL-17水平变化。方法以2015年1月—2016年1月接受关节腔PRP注射治疗(每周1次,连续3周)的30例膝关节OA患者作为研究对象(试验组),以30例自愿者正常膝关节作为对照(对照组)。两组研究对象性别、年龄、体质量指数比较,差异均无统计学意义(P>0.05)。试验组治疗前后采用膝关节学会评分系统(KSS)及疼痛视觉模拟评分(VAS)分别评价膝关节功能及疼痛程度。试验组患者注射PRP之前及第3次注射后1、3、6及12个月抽取肘前静脉血以及患侧关节滑液,采用ELISA法测量IL-17含量;对照组抽取肘前静脉血进行相应检测并比较。结果 PRP注射治疗过程中,试验组患者均未出现膝关节红肿、发热等局部感染及其他不适症状。患者均获随访,随访时间12~15个月,平均13.5个月。PRP注射治疗后各时间点VAS评分均较术前显著降低,KSS评分较术前显著增加,比较差异有统计学意义(P<0.05);治疗后各时间点间比较,差异均无统计学意义(P>0.05)。与对照组比较,试验组PRP治疗前后血浆IL-17含量均显著增高(P<0.05)。试验组治疗后各时间点血浆及关节滑液IL-17含量均较治疗前显著降低(P<0.05),治疗后各时间点间比较差异均无统计学意义(P>0.05)。结论关节腔注射PRP治疗可显著改善膝关节OA患者疼痛症状及关节功能,并在一定程度上降低患者体内IL-17水平,但未恢复至正常水平。

Objective To investigate the interleukin-17 （IL-17） levels changes in both synovial fluid and venous plasma of patients with primary knee osteoarthritis （OA） after intra-articular injection of platelet-rich plasma （PRP）. Methods Between January 2015 and January 2016, 30 patients with primary knee OA were treated by intra-articular injection of PRP once a week for 3 weeks （trial group）. Thirty healthy individuals were recruited into the study as control. There was no significant difference in gender, age, and body mass index between 2 groups （P〉0.05）. Visual analogue scale （VAS） score and Knee Society Score （KSS） were used to evaluate pain level and function of the knee for patients with OA. The IL-17 levels in both venous plasma and synovial fluid were measured before injection and at 1, 3, 6, and 12 months after injection in trial group and the IL-17 levels in venous plasma were measured in control group. The levels were determined using ELISA method. Results There was no knee joint swelling, fever, local infection, or other uncomfortable symptoms for all patients in process of PRP months）. In trial group, the VAS scores at injection. All patients were followed up 13.5 months on average （range, 12-15 different time points after injection were significantly lower than that before injection （P〈0.05）. And the KSS scores at different time points after injection were significantly higher than that before injection （P〈0.05）. There was no significant difference in VAS and KSS scores between different time points after injection （P〉0.05）. The IL-17 levels in venous plasma before and after injection in trial group were significantly higher than that in control group （P〈0.05）. The IL-17 levels in venous plasma at each time point after injection were significantly lower than that before injection （P〈0.05）. There was no significant difference in IL-17 levels in both venous plasma and synovial fluid between different time points after injection （P〉0.05）. Conclusion Intra-articular injection of PRP can significantly release the pain symptoms, improve joint function, and reduce IL-17 levels in both synovial fluid and venous plasma of the patients with knee OA, but IL-17 levels can not reduce to normal level.