膝关节置换术对大骨节病重度膝关节炎患者血清细胞因子及生活质量的影响

Effect of knee arthroplasty on serum cytokines and quality of life in Kashin-Beck disease patients with severe knee arthritis

目的探讨膝关节置换术对大骨节病(KBD)重度膝关节炎患者血清细胞因子及生活质量的影响。方法采用前瞻性设计,选取2017年6月至2018年6月于衢州市中医医院接受全膝关节置换术的患有重度膝关节炎的KBD患者作为研究对象。比较术前、术后6个月和术后1年患者血清细胞因子[白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]及一氧化氮(NO)水平,并进行西安大略和麦马斯特大学骨关节炎指数可视化量表(WOMAC)评分及生命质量量表(KBDQOL)评分。结果34例KBD重度膝关节炎患者年龄为(60.4±5.6)岁,范围为50~72岁;男15例,女19例;病程为(20.3±10.5)年,范围为5~40年。术后6个月和术后1年患者血清IL-1β[(16.49±3.86)、(12.08±1.27)pg/ml]、TNF-α[(9.28±1.45)、(6.52±1.26)pg/ml]及NO水平[(63.58±15.82)、(43.84±10.37)μmol/L]均显著低于术前[(21.65±5.08)、(13.06±2.15)pg/ml,(102.16±20.74)μmol/L,P均<0.05],且术后1年上述指标均显著低于术后6个月(P均<0.05)。术后6个月和术后1年患者WOMAC各维度及综合评分均显著低于术前(P均<0.05),且术后1年WOMAC各维度及综合评分均显著低于术后6个月(P均<0.05)。术后6个月和术后1年患者KBDQOL的社会支持评分、活动限制评分、躯体功能评分、精神状况评分、总的健康评分及总分均显著高于术前(P均<0.05),且术后1年患者总的健康评分和总分均显著高于术后6个月(P均<0.05)。结论KBD重度膝关节炎患者全膝关节置换术后炎症反应、临床症状及生活质量较术前均明显改善。

Objective To explore the effect of knee arthroplasty on serum cytokines and quality of life in Kashin-Beck disease(KBD)patients with severe knee arthritis.Methods In a prospective design,KBD patients with severe knee arthritis who underwent total knee arthroplasty in Quzhou Hospital of Traditional Chinese Medicine from June 2017 to June 2018 were selected as the study subjects.The levels of serum cytokines[interleukin-1β(IL-1β),tumor necrosis factor(TNF)-α]and nitric oxide(NO)were compared before operation,6 months after operation and 1 year after operation.The scores of Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and quality of life scale(KBDQOL)were evaluated.Results The age of 34 KBD patients with severe knee arthritis was(60.4±5.6)years old,ranged from 50 to 72 years old.There were 15 males and 19 females;the course of disease was(20.3±10.5)years,ranged from 5 to 40 years.The levels of serum IL-1β[(16.49±3.86),(12.08±1.27)pg/ml],TNF-α[(9.28±1.45),(6.52±1.26)pg/ml]and NO[(63.58±15.82),(43.84±10.37)μmol/L]at 6 months and 1 year after operation were significantly lower than those before operation[(21.65±5.08),(13.06±2.15)pg/ml,(102.16±20.74)μmol/L,P<0.05],and the levels of the above indicators at 1 year after operation were significantly lower than those at 6 months after operation(P<0.05).The WOMAC dimensions and comprehensive scores of KBD patients at 6 months and 1 year after operation were significantly lower than that before operation(P<0.05),and the WOMAC dimensions and comprehensive scores at 1 year after operation were significantly lower than those at 6 months after operation(P<0.05).The social support,activity limitation,somatic function,mental status,overall health and total scores of patients at 6 months and 1 year after operation were significantly higher than those before operation(P<0.05).The overall health and total scores of patients at 1 year after operation were significantly higher than those at 6 months after operation(P<0.05).Conclusion After total knee arthroplasty,the inflammatory reaction,clinical symptoms and quality of life of KBD patients with severe knee arthritis are significantly improved.