关节腔积液中沉默信息调节因子2相关酶1和肿瘤坏死因子样弱凋亡诱导因子表达与膝骨关节炎的相关性分析

Correlation of expression of silencing information regulator 2 related enzyme 1 and tumor necrosis factor-like weak inducer of apoptosis in articular effusion and knee osteoarthritis

目的:分析关节腔积液中沉默信息调节因子2相关酶1(silencing information regulator 2 related enzyme 1,SIRT1),肿瘤坏死因子样弱凋亡诱导因子(tumor necrosis factor-like weak inducer of apoptosis,TWEAK)表达与膝骨关节炎的相关性。方法:选择2019年2月至2021年8月收治的103例膝骨关节患者(膝骨关节炎组),男40例,女63例,年龄(62.02±6.09)岁。根据改良Mankin评分将患者分为轻度组(Mankin评分1~4分,31例)、中度组(Mankin评分5~8分,40例)和重度组(Mankin评分≥9分,32例),另选择105例体检志愿者为对照组,男46例,女59例,年龄(62.11±6.34)岁。膝骨关节炎组检测关节腔积液和血清中SIRT1、TWEAK水平,对照组仅检测血清SIRT1、TWEAK水平。分析SIRT1、TWEAK与膝骨关节炎发生和病情的关系。结果:膝骨关节炎组关节腔积液TWEAK,血清TWEAK、C反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interleukin,IL-6)、IL-1β、白细胞计数、红细胞沉降率(erythrocyte sedimentation rate,ESR)高于对照组(P<0.05),关节腔积液SIRT1、血清SIRT1低于对照组(P<0.05)。重度组关节腔积液中TWEAK水平高于中度组和轻度组(P<0.05),SIRT1低于中度组和轻度组(P<0.05)。关节腔积液中SIRT1水平与血清SIRT1水平呈正相关(P<0.05),与CRP、IL-6、IL-1β、白细胞计数、改良Mankin评分、ESR呈负相关(P<0.05);关节腔积液中TWEAK水平与血清TWEAK水平呈正相关(P<0.05),与CRP、IL-6、IL-1β、白细胞计数、改良Mankin评分、ESR呈正相关(P<0.05)。身体质量指数、从事重体力工作、关节腔积液TWEAK是膝骨关节炎发生的危险因素(P<0.05),关节腔积液SIRT1是膝骨关节炎发生的保护因素(P<0.05)。关节腔积液SIRT1、TWEAK诊断膝骨关节炎的曲线下面积(area undre curve,AUC)为0.641、0.653,联合关节腔积液SIRT1、TWEAK诊断膝骨关节炎的AUC为0.879,高于单独SIRT1、TWEAK(z=6.105、6.225,P<0.05)。结论:膝骨关节炎患者关节腔积液中SIRT1水平降低,TWEAK水平增高,低SIRT1和高TWEAK与膝骨关节炎发病以及病情加重均有关。

Objective To analyze the correlation between the expression of silencing information regulator 2 related enzyme 1(SIRT1),tumor necrosis factor like weak inducer of apoptosis(TWEAK)and knee osteoarthritis.Methods Total of 103 patients with knee joint(knee osteoarthritis group)from February 2019 to August 2021 were selected including 40 males and 63 females with an average age of(62.026.09)years;according to the modified Mankin score,103 patients were divided into mild group(Mankin score 1-4 points,31 cases)and moderate group(Mankin score 5-8 points,40 cases)and severe group(Mankin score≥9,32 cases).Another 105 physical examination volunteers were selected as the control group including 46 males and 59 females with an average age of(62.11±6.34)years old.The levels of SIRT1 and TWEAK in articular effusion and serum were detected in the knee osteoarthritis group,while serum SIRTI and TWEAK were detected in the control group only.The relationship between SIRT1,TWEAK and the occurrence and disease of knee osteoarthritis were analyzed.Results Articular cavity fluid TWEAK,serum TWEAK,CRP,IL-6,IL-1β,white blood cell count and ESR were higher than those in the control group(P<0.05),articular cavity fluid SIRT1 and serum SIRT1 were lower than those in the control group(P<0.05).TWEAK level in the severe group was higher than that in the moderate and mild groups(P<0.05),SIRT1 was lower than that in the moderate and mild groups(P<0.05).The level of SIRT1 in articular cavity effusion was positively correlated with the serum level of SIRT1(P<0.05),and negatively correlated with CRP,IL-6,IL-1β,white blood cell count,modified Mankin score and ESR(P<0.05).TWEAK level in articular cavity fluid was positively correlated with serum TWEAK level(P<0.05),C-reactive protein(CRP),interleukin(IL)-6,IL-1β,white blood cell count,modified Mankin score and erythrocyte sedimentation rate(ESR)(P<0.05).Body mass index,undertaking heavy physical work,and articular cavity fluid TWEAK were risk factors for the occurrence of knee osteoarthritis(P<0.05),and articular cavity fluid SIRT1 was a protective factor for the occurrence of knee arthritis(P<0.05).The area under curve(AUC)of SIRT1 and TWEAK for knee osteoarthritis was 0.641 and 0.653,and the AUC of SIRT1 and TWEAK for knee osteoarthritis was 0.879,which was higher than SIRT1 and TWEAK alone(z=6.105 and 6.225,P<0.05).Conclusion The level of SIRT1 in articular fluid in patients with knee arthritis is decreased and the level of TWEAK is increased.Low SIRT1 and high TWEAK are associated with the onset and exacerbation of knee osteoarthritis.