尼美舒利辅助全膝置换术治疗膝骨关节炎的疗效及对高迁移率簇蛋白B1、钙结合蛋白(S100A12)的短期影响

Effect of nimesulide-assisted total knee arthroplasty on knee osteoarthritis and its influence on HMGB1 and S100A12

目的探讨尼美舒利辅助全膝置换术治疗膝骨关节炎的治疗效果及其对病人关节液高迁移率簇蛋白B1(HMGB1)、钙结合蛋白S100A12的影响。方法选取2016年2月至2018年11月在天门市第一人民医院接受治疗的96例膝骨关节炎病人作为研究对象,应用随机数字表法分为对照组48例和联合组48例。两组病人均行人工全膝关节置换术治疗,联合组病人同时给予尼美舒利片口服,0.1克/次,2次/天。评价并比较两组病人的治疗效果和治疗前后的膝关节美国特种外科医院功能评分(HSS)、关节活动度、视觉模拟评分(VAS),检测并比较两组病人治疗前后血清白细胞介素1(IL-1)、白细胞介素1(IL-6)、C反应蛋白(CRP)及关节液HMGB1、S100A12水平变化情况。结果术后末次随访评价两组病人的疗效,对照组治疗总有效率为79.17%(38/48),联合组为93.75%(45/48),联合组治疗总有效率显著高于对照组(P<0.05);治疗前两组病人膝关节VAS评分、膝关节HSS评分、膝关节活动度三项指标比较均差异无统计学意义(P>0.05),治疗后相比手术前,两组病人的膝关节HSS评分显著升高,膝关节活动度显著增加,VAS评分显著减小,且治疗后联合组与对照组膝关节三项指标比较均差异有统计学意义[(93.05±7.20)比(82.63±7.96)分,(2.48±0.51)比(4.34±0.85)分,(107.62±8.80)°比(102.82±10.39)°](P<0.05);治疗前两组病人的血清IL-1、IL-6、CRP和关节液HMGB1、S100A12比较均差异有统计学意义(P>0.05),治疗后血清IL-1、IL-6、CRP和关节液HMGB1、S100A12较治疗前均显著降低,且治疗后联合组与对照组血清炎性指标和关节液HMGB1、S100A12比较差异有统计学意义[(73.39±8.95)比(89.74±9.82)ng/L,(109.65±26.33)比(173.40±33.71)ng/L,(8.72±4.46)比(14.50±7.72)mg/L,(3.85±1.16)比(5.33±1.97)ρg/mL,(8.26±4.12)比(11.09±5.88)ng/mL](P<0.05)。结论尼美舒利辅助全膝关节置换术治疗膝骨关节炎可进一步提高手术治疗的疗效,有助于显著改善病人的临床症状和膝关节功能,降低血清炎性因子水平和关节液HMGB1、S100A12水平,关节液HMGB1、S100A12检测可为膝骨关节炎的临床治疗提供参考。

Objective To investigate the therapeutic effect of nimesulide-assisted total knee arthroplasty(TKA)on knee osteoarthritis and its effect on high mobility cluster protein B1(HMGB1)and calcium binding protein S100 A12 in synovial fluid.Methods Ninety-six cases of knee osteoarthritis patients who received treatment inTianmen First People’s Hospital from February2016 to November 2018 were selected as the research objects.They were randomly assigned into the control group(48 cases)and the combined group(48 cases)using the random number table method.Patients in the two groups were treated with artificial total knee arthroplasty.The combined group was given nimesulide tablets orally at the same time,0.1 g/time,2 times/day.The therapeutic effect of the two groups,the scores of hospital for special surgery(HSS),joint mobility and visual analogue scale(VAS)before and after treatment were evaluated and compared.The serum interleukin(IL)-1,IL-6,C-reactive protein(CRP)and joint of the two groups before and after treatment,changes of liquid HMGB1 and S100 A12 levels were compared.ResultsThe total effective rate of the two groups was 79.17%(38/48)in the control group and 93.75%(45/48)in the combined group.The total effective rate of the combined group was significantly higher than that of the control group(P<0.05);the HSS score,activity of the two groups were significantly increased,and the VAS score was significantly decreased.There were significant differences in HSS score[(93.05±7.20)points vs.(82.63±7.96)points,VAS score[(2.48±0.51)points vs.(4.34±0.85)points]and knee joint activity[(107.62±8.80)°vs.(102.82±10.39)°]between the two groups after treatment(P<0.05);serum IL-1,IL-6,CRP,synovial fluid HMGB1 and S100 A12 of patients in the two groups before treatment were significantly different(P>0.05);serum IL-1,IL-6,CRP,synovial fluid HMGB1,and S100 A12 of patients after treatment were significantly lower than before treatment,and there were significant differences in serum inflammatory indexes IL-1[(73.39±8.95)ng/L vs.(89.74±9.82)ng/L],IL-6[(109.65±26.33)ng/L vs.(173.40±33.71)ng/L],CRP[(8.72±4.46)mg/L vs.(14.50±7.72)mg/L],joint fluid HMGB1[(3.85±1.16)ρg/mL vs.(5.33±1.97)ρg/mL],and S100 A12[(8.26±4.12)ng/mL vs.(11.09±5.88)ng/mL]between the combined group and the control group after treatment(P<0.05).Conclusion Nimesulide-assisted total knee arthroplasty can further improve the curative effect of surgical treatment for knee osteoarthritis,help to significantly improve clinical symptoms and knee function,reduce serum levels of inflammatory factors and levels of HMGB1 and S100 A12 in synovial fluid.Detection of HMGB1 and S100 A12 in synovial fluid can provide reference for clinical treatment of knee osteoarthritis.