膝关节骨性关节炎患者滑膜和关节液中miR-29a和VEGF的表达水平及意义

Levels of miR-29a and VEGF in synovium and synovial fluid of patients with knee osteoarthritis and their clinical significances

目的探究微小RNA-29a(miR-29a)、血管内皮生长因子(VEGF)在膝关节骨性关节炎(KOA)患者滑膜和关节液中的表达水平及其临床意义。方法选取收治的KOA患者104例为研究对象,并以同期半月板损伤患者104例作为对照组,采用实时荧光定量(qRT-PCR)法检查所有受试者滑膜和关节液中miR-29a、VEGF表达水平;利用Pearson相关性分析KOA患者滑膜、关节液中miR-29a、VEGF mRNA表达水平的相关性;利用受试者工作特征(ROC)曲线评价miR-29a、VEGF mRNA及两者联合对KOA的诊断价值。结果与对照组相比,KOA患者滑膜、关节液中miR-29a表达水平均明显降低(P<0.05),VEGF表达水平均明显升高(P<0.05);与Ⅱ级组患者相比,Ⅲ、Ⅳ级组患者滑膜、关节液中miR-29a表达水平均明显降低(P<0.05),且随分级增高降低越明显;与Ⅱ级组患者相比,Ⅲ、Ⅳ级组患者滑膜、关节液中VEGF表达水平均明显升高(P<0.05)。KOA患者滑膜、关节液中miR-29a表达水平与VEGF表达水平均呈负相关(P<0.05);滑膜、关节液miR-29a对KOA诊断的ROC曲线下面积(AUC)分别为0.857、0.830,截断值分别为0.855、0.785,此时敏感度分别为83.7%、67.3%,对应特异度为71.8%、84.6%;滑膜、关节液VEGF对KOA诊断的AUC分别为0.928、0.896,截断值分别为1.306、1.492,此时敏感度分别为78.8%、83.7%,对应特异度为93.3%、87.5%;两者联合诊断KOA滑膜、关节液中的AUC分别为0.954、0.963,敏感度分别为90.4%、93.3%,对应特异度分别为90.4%、88.5%。结论KOA患者滑膜、关节液中miR-29a低表达,VEGF高表达,滑膜、关节液中两者呈负相关,两者联合可提高KOA的诊断价值。

Objective To investigate the expressions of microRNA-29 a(miR-29 a)and vascular endothelial growth factor(VEGF)in synovium and synovial fluid of patients with knee osteoarthritis(KOA)and their clinical significances.Methods A total of 104 patients with KOA admitted to our hospital from January 2017 to November 2018 were selected as the study subjects,and 104 patients with meniscus injury during the same period were selected as the control group.Real-time fluorescence quantitative(qRT-PCR)was used to assess the expression of miR-29 a and VEGF in synovium and joint fluid of all subjects.Pearson correlation was used to analyze the correlation between the expression levels of miR-29 a and VEGF in synovial and synovial fluid of KOA patients,and the ROC curve was used to evaluate the diagnostic values of miR-29 a and VEGF mRNA and their combination in KOA.Results Compared with the control group,the expression of miR-29 a in synovium and synovial fluid of KOA patients was significantly lower(P<0.05),and the expression of VEGF was significantly higher(P<0.05).Compared with GradeⅡgroup,the expression levels of miR-29 a in synovial membrane and synovial fluid of GradeⅢandⅣgroups were significantly reduced(P<0.05),which were more prominent in GradeⅣgroup.While compared with GradeⅡgroup,the expression of VEGF in synovium and synovial fluid of GradeⅢgroup and that in synovial fluid of GradeⅣgroup were significantly increased(P<0.05).The expression of miR-29 a in synovium and synovial fluid of KOA patients was significantly negatively correlated with the expression of VEGF(P<0.05).The areas under curve(AUC)of miR-29 a in synovial membrane and synovial fluid for KOA diagnosis were 0.857 and 0.830,respectively;and the truncation values were 0.855 and 0.785,respectively.The sensitivities were 83.7%and 67.3%respectively;with the corresponding specificities of 71.8%and 84.6%,respectively.The AUCs of synovial and synovial fluid VEGF in the diagnosis of KOA were 0.928 and 0.896,respectively;and the truncation values were 1.306 and 1.492,respectively.The sensitivities were 78.8%and 83.7%respectively;and the corresponding specificities were 93.3%and 87.5%,respectively.The AUCs of combination detection of synovial and synovial fluid miR-29 a and VEGF for KOA were 0.954 and 0.963,respectively;with the sensitivities of 90.4%and 93.3%,respectively;and the corresponding specificities of 90.4%and 88.5%,respectively.Conclusion The expression of miR-29 a in synovium and synovial fluid of KOA patients is low,while the expression of VEGF is high.There is a negative correlation between them in synovium and synovial fluid.The combination dectetion of them can improve the diagnosis of KOA.