膝关节骨关节炎滑膜中神经生长因子和P物质水平测试与观察

The observation of nerve growth factor and substance Pin synovium of knee osteoarthritis

目的比较神经生长因子(nervegrowthfactor,NGF)和P物质(substanceP,SP)在膝骨性关节炎(osteoarthritis,OA)和单纯半月板撕裂膝关节滑膜中不同部位的表达。方法应用免疫组化的方法定性和半定量分析NGF和SP在膝OA(13例次)及单纯半月板撕裂患者(6例次)膝关节不同部位滑膜中的表达。用Gless神经纤维染色法观察滑膜内神经纤维的分布。结果NGF主要在滑膜的血管壁平滑肌层表达,OA膝内下方滑膜的NGF阳性血管率(67.2%)明显高于外侧滑膜(47.6%,P<0.05)和髌上囊处滑膜(29.9%)的表达以及单纯半月板撕裂膝关节内下方(38.9%)、外侧(41.0%)、髌上囊处(32.2%)滑膜的表达(P<0.01)。SP在滑膜血管壁上表达,OA膝内下方滑膜SP的表达(61.7%)明显高于外侧滑膜的表达(46.5%,P<0.05)和在髌上囊滑膜(31.6%)的表达以及单纯半月板撕裂膝关节内下方(43.1%)、外侧(40.5%)和髌上囊(33.2%)处滑膜的表达(P<0.01)。滑膜内的神经纤维分布广泛,在血管周围尤为明显,形成血管周围神经网。结论NGF和SP在膝OA滑膜内下方的表达明显高于它们在滑膜其它处的表达,与临床观察到的膝OA患者膝内下方疼痛和压痛部位一致。

Objective To investigate the pathogenesis of pain around the medial site of knee joint in osteoarthritis, the expressions of nerve growth factor (NGF) and substance P (SP) were observed in the synovial membrane of medial, lateral, and suprapatellar sites of knees in osteoarthritis and simple meniscus tear. Methods Synovial tissues were obtained from medial, lateral, and suprapatellar sites of 13 knees (12 patients with an average age of 57 years) with OA at surgery. Synovial tissues as control were harvested from medial, lateral, and suprapatellar sites of 6 knees (6 patients with an average of 52 years) and simple meniscus tear during the arthroscopic operation. The tissues were cut into small fragments, fixed with formalin and then embedded in paraffin. The expressions of NGF and SP in synovium of the knees were detected using immunohistochemical staining. Gless nerve fiber staining was adopted to observe the distribution of nerve fibers in synovium of the knee. Results NGF revealed in granular pattern in the muscular wall of the vessels in synovium. The positive vessel rates of NGF in the medial synovium of knee osteoarthritis (67.2%) were higher than those in lateral synovium (47.6%,P<0.05) and suprapatellar synovium (29.9%,P<0.01), and also than those in medial (38.9%), lateral (41.0%), and suprapatellar synovium (32.2%) of knees with simple meniscus tear (P<0.01). SP was manifested in granular pattern in the vessel walls of synovium. The positive vessel rates of SP in the medial synovium of knee osteoarthritis (61.7%) were obviously higher than those in lateral synovium (46.5%, P<0.05) and suprapatellar synovium (31.6%,P<0.01), and also than those in medial (43.1%), lateral (40.5%) and suprapatellar synovium (33.2%) of knee with simple meniscus tear (P<0.01). Nerve fibers existed widely in synovium of the knees, forming the nerve networks especially around the vessels. Conclusion The expressions of NGF and SP in medial synovium of knee osteoarthritis are significantly higher than those in other sites of knee. It is consistent with the clinical findings that patients with knee osteoarthritis have obviously pain and tenderness in the medial knee. It may be one of the causes of the pain.