膝骨关节炎肝肾亏虚证患者影像学、炎症因子特征研究

Characterization of Imaging and Inflammatory Factors in Patients with Osteoarthritis of the Knee with Liver and Kidney Deficiency Syndrome

目的探讨肝肾亏虚型膝骨关节炎(knee osteoarthritis,KOA)患者与非肝肾亏虚型患者的影像学特征及其与炎症因子的差异性。方法收集66例KOA患者的临床资料,按患者中医辨证分型,分为肝肾亏虚组(观察组)和非肝肾亏虚型组(对照组),每组33例。分析比较肝肾亏虚证与非肝肾亏虚证患者的影像学特征与炎症因子水平。结果(1)MRI结果显示,与对照组比较,观察组患者关节软骨损伤和关节面磨损评分差异具有统计学意义(P<0.05);观察组患者在韧带损伤、半月板损伤、关节积液、关节游离体等改变方面与对照组比较,差异无统计学意义(P>0.05);观察组、对照组以及两组KOA患者的软骨损伤与关节面磨损评分均呈正相关性,分别为r=0.8626,P<0.05;r=0.3665,P<0.05;r=0.4010,P<0.05。(2)观察组与对照组患者的关节液中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平比较,差异具有显著统计学意义(P<0.05)。(3)两组患者中医证候评分比较,差异无统计学意义(P>0.05)。结论软骨损伤、关节面磨损可能是肝肾亏虚型KOA患者的MRI典型征象。肝肾亏虚型KOA患者关节液炎症因子降低,说明有其他的损伤机制存在,其中的发病机制有待进一步研究。

Objective To investigate the imaging characteristics of patients with knee osteoarthritis(KOA)of liver and kidney deficiency type and patients with non-liver and kidney deficiency type and the differences between them and inflammatory factors.Methods Clinical data of 66 patients with KOA were collected,and according to the patients'traditional Chinese medicine dialectical typing,they were divided into the liver and kidney deficiency group(observation group)and the non-liver and kidney deficiency type group(control group),with 33 cases in each group.We analyzed and compared the imaging characteristics and inflammatory factor levels of patients with liver and kidney deficiency syndrome and non-liver and kidney deficiency syndrome.Results(1)The MRI results showed that the differences in articular cartilage damage and articular surface wear scores of observation group were statistically significant compared with control group(P<0.05);the differences between observation group and control group in terms of changes such as ligament damage,meniscus damage,joint effusion,and articular free bodies may not be statistically significant(P>0.05);the differences between observation group,control group,and both groups of KOA patients showed positive correlation between cartilage damage and articular surface wear scores,with r=0.8626,P<0.05;r=0.3665,P<0.05;and r=0.4010,P<0.05,respectively.(2)In the articular fluids of observation group and the control group,the difference in IL-1βand TNF-αlevels were statistically significant(P<0.05).(3)The TCM evidence score scores of the patients in the control group and the observation group were compared,and the difference was not statistically significant(P>0.05).Conclusion Cartilage damage and articular surface wear may be the typical signs of MRI in patients with KOA with deficiency of liver and kidney.The decreased inflammatory factor of joint fluid in patients with liver and kidney deficiency type KOA suggests the existence of other injury mechanisms,of which the pathogenesis needs to be further studied.