膝关节骨关节炎外周血标志物变化的临床研究

Clinical study on changes of peripheral blood markers of knee osteoarthritis

目的:探讨外周血清学指标在膝骨关节炎中的变化及诊断价值。方法:收集2013年1月至2018年1月就诊华中科技大学同济医学院附属武汉市中心医院新洲院区骨科的228例行全膝关节置换术(total knee arthroplasty,TKA)的膝骨关节炎患者(knee osteoarthritis,KOA)及120例健康体检志愿者的血清学指标检查资料。记录所有参与者的年龄、性别、血中性粒细胞百分比(neutrophil percentage,NEU%)、中性粒细胞计数、单核细胞计数、淋巴细胞计数、红细胞分布宽度(red blood cell distribution width,RDW-CV)、血清碱性磷酸酶(alkaline phosphatase,ALP)和血尿酸(uric acid,UA)等指标,计算中性粒细胞-淋巴细胞比率(neutrophil-lymphocyte ratio,NLR)、单核细胞-淋巴细胞比率(monocyte-lymphocyte ratio,MLR),并比较2组差异,绘制受试者操作工作曲线(receiver operating curve,ROC)确定诊断阈值。随访TKA术后1 d、3个月、6个月及1年的膝关节HSS评分并与血NLR、MLR作相关性分析。结果:膝骨关节炎患者外周血NLR、MLR和RDW-CV明显高于健康体检志愿者(P<0.001),且ROC曲线示NLR≥2.005、MLR≥0.165及RDW-CV≥12.45为骨关节炎诊断阈值。术后仅有26例骨关节炎患者完成整个随访过程并发现随膝关节HSS评分的升高,外周血NLR、MLR逐渐降低,二者具有显著相关性。结论:膝骨关节炎患者外周血NLR、MLR及RDW-CV能够反映骨关节炎进程且NLR、MLR对预估TKA术后膝关节功能有参考价值。

Objective:To study the changes and diagnostic value of peripheral serological indexes in knee osteoarthritis. Methods:A total of 228 patients with knee osteoarthritis(KOA)admitted to our hospital undergoing total knee arthroplasty(TKA)from January2013 to January 2018 and 120 healthy volunteers were enrolled in this study. They were divided into KOA group and healthy control group. Demographic parameters,blood neutrophil percentage(NEU%),monocyte count,lymphocyte count,red blood cell distribution width(RDW-CV),serum alkaline phosphatase(ALP),and serum uric acid(UA)of all participants were recorded,and the neutrophillymphocyte ratio(NLR)and monocyte-lymphocyte ratio(MLR)were calculated and compared between the two groups. Then the receiver operating curve(ROC)was drawn to determine the diagnostic threshold. The HSS scores of knee joint at 1 day,3 months,6 months and 1 year after TKA were followed up,and the correlation between HSS scores and NLR and MLR was analyzed. Results:Elevated blood NLR,MLR and RDW-CV were apparent features in KOA patients compared with healthy individuals(P<0.001)and NLR≥2.005,MLR≥0.165 and RDW-CV≥12.45 were the diagnostic thresholds for KOA based on the ROC characteristics. These blood indictors of only 26 patients with KOA were followed up for one year after TKA,and the results indicated that NLR and MLR were gradually reduced with the improvement of knee joint HSS scores,with significant correlation. Conclusion:Our present results show that both NLR,MLR and RDW-CV are promising peripheral blood markers of KOA,and the NLR and MLR may be served as the serum markers to predict the prognosis of TKA.