全髋关节置换术联合生物制剂治疗髋骨关节炎的效果及对S100A12、基质金属蛋白酶-13水平的影响

Therapeutic effect of biologics in patients with hip osteoarthritis

目的观察全髋关节置换术联合生物制剂治疗髋骨关节炎(HOA)的效果,以及对钙结合蛋白S100A12、基质金属蛋白酶-13(MMP-13)水平的影响。方法选取2016年6月-2017年12月浙江中医药大学附属第一医院收治的128例HOA患者,根据随机数字表法分成观察组和对照组,对照组予以髋关节置换术联合常规治疗,观察组在此基础上加用生物制剂治疗,观察两组手术时间、术中出血量、术后引流量,观测治疗前后疼痛评分、Harris评分、血清C反应蛋白(CRP)、白细胞介素-18(IL-18)、S100A12、MMP-13水平,评价患者治疗前后影像学K-L分级以及不良反应情况。结果两组患者术中出血量、手术时间以及术后引流量差异无统计学意义(P>0.05);两组治疗12周后,疼痛评分降低,Harris评分升高,且观察组均优于对照组(P<0.05);治疗后,两组患者血清CRP及IL-18水平均降低,且观察组各指标更低于对照组(P<0.05);两组患者血清S100A12、MMP-13水平均较治疗前降低,且观察组各指标更低于对照组(P<0.05);两组患者K-L分级均较治疗前降低,且观察组与对照组比较,差异有统计学意义(P<0.05);观察组影像学稳定率高于对照组(P<0.05);两组患者均未发生不良反应。结论全髋关节置换术联合生物制剂治疗HOA,能改善患者髋骨关节功能,改善血清炎症指标以及S100A12、MMP-13水平,具有较好的安全性。

Objective To observe the therapeutic effect of biological agents in the treatment of hip osteoarthritis patients undergoing total hip arthroplasty(THA). Methods A total of 128 patients with HOA who were admitted into our hospital from June 2016 to December 2017 were randomly divided into observation group and control group. All patients were given THA combined with routine treatment. The observation group was given additional biologics. The pain score, Harris score, serum CRP, IL-18, S100 A12 and MMP-13 levels were observed before and after treatment.The imaging K-L classification and adverse reactions were evaluated before and after treatment. Results There was no significant difference in blood volume, operation time or postoperative drainage volume between the two groups(P > 0.05). Pain score decreased while the Harris score increased significantly after 12 weeks of treatment when compared with those prior to any treatments(P < 0.05), which was more obvious in the observation group when compared with those in control group(P < 0.05). The serum levels of CRP, IL-18, S100 A12 and MMP-13 as well as K-L classification were decreased significantly after treatment when compared with those prior to any treatments(P < 0.05), which was more dramatic in observation group when compared with those in control group(P < 0.05).The image stabilization rate of observation group was significantly higher than that of the control group(P < 0.05)while there was no significant adverse reaction between the two groups. Conclusions Total hip arthroplasty combined with biological agents exerts improvement in hip joint function recovery probably through modulation on inflammatory response and S100 A12/MMP-13 related signal pathways.