胫骨高位截骨术后血小板miRNA的表达水平及临床意义

Expression and clinical significance of platelet miRNA after high tibial osteotomy

目的:探讨外侧闭合胫骨高位截骨术对膝关节活动功能恢复的影响及意义。方法:自2018年2月至12月,选择初次接受胫骨高位截骨术治疗的78例膝骨关节炎患者作为观察组,男46例,女32例,年龄55~73(61.78±6.39)岁;病程6~24(16.52±4.25)个月;Kellgren-Lawrence(K-L)分级,Ⅱ级36例,Ⅲ级42例。另选取20例健康人作为健康组,男13例,女7例,年龄56~73(60.89±7.12)岁。比较观察组和健康组的外周血miR-146相对表达量。同时对观察组患者进行6个月的随访,将随访期间膝关节活动功能恢复正常或较术前明显改善的患者纳为有效组;而膝关节功能未有明显改善或呈加重趋势的患者纳为无效组。分析有效组和无效组的临床资料及血清miR-146相对表达量和白细胞介素-6(interleukin-6,IL-6)的表达水平。结果:观察组miR-146相对表达量高于健康组(t=3.749,P<0.05)。随访6个月结果显示,无效组15例(19.23%),有效组63例(80.77%)。有效组的血清miR-146相对表达量和IL-6表达水平均低于无效组(P<0.05)。ROC曲线分析及最大约登指数计算出血清miR-146、IL-6指标最大曲线下面积(area under curve,AUC)分别为0.859、0.702;其截断值分别为0.98(灵敏度=86.30%,特异度=93.20%)和175.65(灵敏度=72.80%,特异度=69.50%)。结论:血清miR-146表达水平呈上升趋势,调控软骨细胞分化。监测患者术后的miR-146指标,对预测患者术后骨关节活动功能恢复状况具有参考价值。

Objective:To explore effect and significance of lateral closed high tibial osteotomy on recovery of activity of knee joint.Methods:From February to December 2018,78 patients with knee osteoarthritis who were treated by high tibial osteotomy for the first time were selected as the observation group,including 46 males and 32 females,aged from 55 to 73 years old with an average age of(61.78±6.39)years old,the course of disease ranged from 6 to 24 months with an average of(16.52±4.25)months;according to Kellgren-Lawrence(K-L)grading,36 patients were grade Ⅱ and 42 patients were grade Ⅲ.Another 20 healthy people were selected as healthy group,including 13 males and 7 females,aged from 56 to 73 years old with an average of(60.89±7.12)years old.The expression of miR-146 in peripheral blood was compared between observation group and healthy group.At the same time,patients in observation group were followed up for 6 months.The patients whose knee joint function returned to normal or improved significantly during the follow-up period were admitted as the effective group,while the patients whose knee joint function did not improve significantly or tended to aggravate were admitted as the ineffective group.The clinical data and the relative expression of serum miR-146 between effective group and ineffective group were analyzed.Results:The relative expression of serum miR-146 in observation group after operation was significantly higher than that in healthy group(P<0.05).The results of six months follow-up showed that 15 patients(19.23%)in ineffective group and 63 patients(80.77%)in effective group.Relative expression of miR-146 and interleukin-6(IL-6)in ineffective group were higher than that of effective group(P<0.05).ROC curve analysis and maximum Yoden index were used to calculate the truncation values of the maximum area under curve(AUC)of serum miR-146 and IL-6,which was 0.859 and 0.702 respectively.The truncation values of miRNA-146 and IL-6 were 0.98(sensitivity was 86.30%,specificity was 93.20%)and 175.65(sensitivity was 72.80%,specificity was 69.50%).Conclusion:The expression level of serum miR-146 showed upward trend,which could regulate the differentiation of chondrocyte.The monitoring of miR-146 after operation has reference value for predicting the recovery of bone and joint function after operation.