膝骨关节炎不同证候患者多配体蛋白聚糖-4浓度及全身炎症反应指数特点研究

Study of the Horizontal Characteristics of Syndecan-4 and Systemic Immune-Inflammation Index of Patients with Different Syndromes of Knee Osteoarthritis

目的:研究膝骨关节炎(Knee Osteoarthritis,KOA)肝肾亏虚证和痰瘀互结证患者关节液多配体蛋白聚糖-4(Syndecan-4)和外周血全身炎症反应指数(SII)特点及其与证候间的相关性。方法:应用横断面研究方法,留取并测定58例膝骨关节炎肝肾亏虚证和痰瘀互结证患者关节液多配体蛋白聚糖-4和外周血全身炎症反应指数,通过中医证候量表评定患者证候,分析关节液多配体蛋白聚糖-4和外周血全身炎症反应指数特点及其与证候间的相关性。结果:膝骨关节炎痰瘀互结证和肝肾亏虚证患者一般情况和Kellgren-Lawrence分级差异无统计学意义(P>0.05)。膝骨关节炎肝肾亏虚证患者关节液多配体蛋白聚糖-4的浓度高于痰瘀互结证患者,差异有统计学意义(P<0.05)。膝骨关节炎痰瘀互结证患者外周血全身炎症反应指数高于肝肾亏虚证患者,差异有统计学意义(P<0.05)。膝骨关节炎肝肾亏虚证患者关节液多配体蛋白聚糖-4的浓度与中医证候评分正相关,差异有统计学意义(r=0.471,P<0.05)。结论:膝骨关节炎痰瘀互结证和肝肾亏虚证患者关节液多配体蛋白聚糖-4和外周血全身炎症反应指数水平存在差异,提示不同证候患者具有炎症水平不同的特点,并且膝骨关节炎肝肾亏虚证患者多配体蛋白聚糖-4浓度与证候严重程度正相关,其作用机制可能与TGF-β/Samd信号通路受到多配体蛋白聚糖-4蛋白的抑制作用有关;上述特点与膝骨关节炎的中医病因病机具有一致性,丰富了证候物质学的内涵。

Objective:To investigate the horizontal characteristics of syndecan-4 and systemic immune-inflammation index(SII)and its correlation with the degree of traditional Chinese medicine(TCM)syndrome in knee osteoarthritis(KOA)patients with phlegm-stasis syndrome and liver-kidney deficiency syndrome.Methods:The cross-sectional research methods was performed.The concentrations of syndecan-4 in articular fluid and SII in blood of 58 patients with different syndromes of knee osteoarthritis were measured and quantified by TCM syndrome scale.The characteristics of syndecan-4 and SII of patients with different syndrome types and their correlation with TCM syndrome score were analyzed.Results:There was no statistically significant difference of general situation and Kellgren-Lawrence classification in the 58 patients(P>0.05).The concentration level of syndecan-4 in knee osteoarthritis patients with liver-kidney deficiency syndrome was higher than patients with phlegm-stasis deficiency syndrome(P<0.05),and the concentration level of SII in knee osteoarthritis patients with phlegm-stasis syndrome was higher(P<0.05).The concentration level of syndecan-4 in articular fluid of KOA patients with liver and kidney deficiency syndrome was positively correlated with the TCM syndrome score,and the results were statistically significant(r=0.471,P<0.05).Conclusion:The concentration level of syndecan-4 and SII between patients with phlegm-stasis interaction syndrome and liver-kidney deficiency syndrome of knee osteoarthritis are different,which can reflect the severity of TCM syndromes to a certain extent,consistent with the analysis of the etiology and pathogenesis of TCM.The mechanism of the above results may be related to the TGF-β/Samd signaling pathway is inhibited by syndecan-4 protein.The above characteristics are consistent with the etiology and pathogenesis of KOA in TCM,which adds richness to the connotation of syndrome materialism.