膝关节滑液白细胞介素1β、白细胞介素17、前列腺素E2含量与老年膝骨关节炎预后的关系研究

The relationship between the prognosis of knee osteoarthritis and the contents of interleukin-1β,interleukin-17 and prostaglandin E2 in knee synovial fluid in the aged

目的:探究膝关节滑液白细胞介素(interleukin,IL)-1β、IL-17、前列腺素E2(prostaglandin E2,PGE2)含量与老年膝骨关节炎(knee osteoarthritis,KOA)预后的关系。方法:选择110例老年KOA患者和60例单纯半月板损伤患者作为研究对象。入院后测定其膝关节滑液IL-1β、IL-17、PGE2含量。依据治疗6个月后的Lysholm膝关节评分评价KOA患者的预后,Lysholm评分≥70分为预后良好、Lysholm评分<70分为预后不良。比较老年KOA患者与单纯半月板损伤患者,以及老年KOA患者中预后良好者与预后不良者的膝关节滑液IL-1β、IL-17、PGE2含量。以老年KOA患者膝关节滑液IL-1β、IL-17、PGE2含量为自变量,以患者是否发生预后不良为因变量进行Logistic回归分析。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析评价采用膝关节滑液IL-1β、IL-17、PGE2含量预测老年KOA预后的灵敏度、特异度、准确度,并测定曲线下面积(areaunder curve,AUC)。结果:老年KOA患者的膝关节滑液IL-1β、IL-17、PGE2含量均高于单纯半月板损伤者[(79.13±13.17)pg·mL^(-1),(24.89±4.15)pg·mL^(-1),t=34.018,P=0.000;(30.31±5.07)pg·mL^(-1),(11.05±1.85)pg·mL^(-1),t=30.906,P=0.000;(325.41±54.29)pg·mL^(-1),(207.96±34.71)pg·mL^(-1),t=15.785,P=0.000]。老年KOA患者中预后良好者的膝关节滑液IL-1β、IL-17、PGE2含量均低于预后不良者[(69.71±8.71)pg·mL^(-1),(86.32±10.79)pg·mL^(-1),t=8.183,P=0.000;(23.01±3.84)pg·mL^(-1),(39.63±6.61)pg·mL^(-1),t=16.195,P=0.000;(235.37±25.69)pg·mL^(-1),(366.31±38.73)pg·mL^(-1),t=20.282,P=0.000]。Logistic回归分析结果显示,膝关节滑液IL-1β、IL-17、PGE2含量均为老年KOA预后不良的危险因素[OR=3.117,95%CI(1.545,4.690);OR=4.899,95%CI(1.749,8.049);OR=5.376,95%CI(1.845,8.908)]。ROC分析结果显示,采用膝关节滑液IL-1β、IL-17、PGE2含量预测老年KOA预后的灵敏度分别为89.29%、82.14%、78.57%,特异度分别为85.37%、82.93%、76.83%,准确度分别为87.27%、85.45%、81.82%,AUC分别为0.815、0.801、0.780。结论:膝关节滑液IL-1β、IL-17、PGE2含量均为老年KOA预后不良的危险因素,也可作为预测老年KOA预后的指标。

Objective:To explore the relationship between the prognosis of knee osteoarthritis(KOA)and the contents of interleukin(IL)-1β,IL-17 and prostaglandin E2(PGE2)in knee synovial fluid in the aged.Methods:One hundred and ten aged patients with KOA and 60 patients with simple meniscus injury were selected out as the subjects, and the contents of IL-1β,IL-17 and PGE2 in their knee synovial fluid were measured after hospital admission.The prognosis of KOA was evaluated according to the Lysholm knee scores measured after 6-month treatment.The Lysholm score of ≥70 points was classified as favorable prognosis, while the Lysholm score of<70 points as unfavorable prognosis.The contents of IL-1β,IL-17 and PGE2 in knee synovial fluid were compared between aged patients with KOA and patients with simple meniscus injury as well as between aged KOA patients with favorable prognosis and aged KOA patients with unfavorable prognosis.The Logistic regression analysis was conducted by taking the contents of IL-1β,IL-17 and PGE2 in knee synovial fluid as independent variable and whether unfavourable prognosis was occurred as dependent variable respectively.The prognoses of aged KOA patients were predicted using the contents of IL-1β,IL-17 and PGE2 in knee synovial fluid and the sensitivity, specificity and accuracy of prediction were analyzed and evaluated by using receiver operating characteristic(ROC)curve, and the area under curve(AUC)was measured.Results:The contents of IL-1β,IL-17 and PGE2 in knee synovial fluid were higher in aged patients with KOA compared to patients with simple meniscus injury(79. 13 ± 13. 17 vs 24. 89 ± 4. 15 pg/mL,t = 34. 018,P = 0. 000;30. 31 ± 5. 07 vs 11. 05 ±1. 85 pg/mL,t = 30. 906,P = 0. 000;325. 41 ± 54. 29 vs 207. 96 ± 34. 71 pg/mL,t = 15. 785,P = 0. 000),whereas they were lower in aged KOA patients with favorable prognosis compared to patients with unfavorable prognosis(69. 71 ± 8. 71 vs 86. 32 ± 10. 79 pg/mL,t = 8. 183,P = 0. 000;23. 01 ± 3. 84 vs 39. 63 ± 6. 61 pg/mL,t = 16. 195,P = 0. 000;235. 37 ± 25. 69 vs 366. 31 ± 38. 73 pg/mL,t = 20. 282,P =0. 000). The results of logistic regression analysis revealed that the contents of IL-1β,IL-17 and PGE2 in knee synovial fluid were the risk factors for unfavorable prognosis of KOA in aged patients(OR = 3. 117,95% CI(1. 545,4. 690);OR = 4. 899,95% CI(1. 749,8. 049);OR = 5. 376,95% CI(1. 845,8. 908)). The results of ROC analysis showed that the sensitivities of prediction of prognosis in aged KOA patients using the contents of IL-1β,IL-17 and PGE2 in knee synovial fluid were 89. 29%,82. 14% and 78. 57%;the specificities were85. 37%,82. 93% and 76. 83%;the accuracies were 87. 27%,85. 45% and 81. 82% respectively;and their AUC were 0. 815,0. 801 and 0. 780 respectively. Conclusion: The contents of IL-1β,IL-17 and PGE2 in knee synovial fluid are the risk factors for unfavorable prognosis of KOA in aged patients,and they can also be used as the indexes for predicting prognosis of KOA in aged patients.