膝骨性关节炎患者血清和关节液FGF-21与IL-1及TNF-a水平的变化及意义

目的探讨膝骨关节炎（Knee osteoarthritis，KOA）患者血清、关节液中成纤维细胞生长因子-21（Fibroblast growth factor 21，FGF-21）、白介素-1（interleukin-1，IL-1）、肿瘤坏死因子-a（tumor necrosis factor-a，TNF-a）的水平变化情况，阐述其在膝骨关节炎发病过程中的作用。方法采用酶联免疫吸附测定法（Enzyme-linked immunosorbent assay，ELISA）检测2013年3月至2015年12月本院门诊及住院部诊治的97例膝骨关节炎患者血清、关节液中FGF-21、IL-1、TNF-a的含量。其中，97例KOA患者依据膝关节X线的Kellgren ＆ Lawrence（K-L）分级，分为对照组（KOA 0级，n=18）和实验组（KOA 1，n=20；KOA 2，n=20；KOA 3，n=19；KOA 4，n=20）。结果与对照组血清FGF-21水平[（323.15±97.63）pg/ml]相比较，实验组各组血清FGF-21水平变化不大，差异无统计学意义（均P〉0.05）。实验组各组间血清IL-1、TNF-a水平随着膝骨关节炎疾病进程，浓度逐渐增大，差异有统计学意义（均P〈0.05）。与对照组关节液FGF-21水平[（198.23±65.41）pg/ml]、IL-1水平[（36.17±6.89）pg/ml]、TNF-a水平[（18.94±5.81）pg/ml]相比较，实验组各组关节液FGF-21、IL-1、TNF-a水平随着膝骨关节炎疾病进程，浓度逐渐增大，差异有统计学意义（均P〈0.05）。相关性分析结果表明，血清IL-1、TNF-a水平与K-L分级呈现正相关（相关系数r=0.899、0.942，P〈0.05），而血清FGF-21与K-L分级呈现负相关（相关系数r=-0.121，P〉0.05）。关节液FGF-21、IL-1、TNF-a水平与K-L分级均呈现正相关（相关系数r=0.876、0.941、0.916，P〈0.05）。结论膝骨关节炎血清及关节液FGF-21、IL-1与TNF-a因子参与膝骨关节炎疾病进程，有一定的参考意义。

Adjunctive effects of acupressure therapy on pain and quality of life in patients with knee osteoarthritis:an interventional study

Objective To investigate the effect of acupressure therapy as an adjunctive therapy to pharmacological treatment on pain and health-related quality of life(QOL)among knee osteoarthritis(KOA)patients.Methods One hundred KOA patients were recruited from the orthopedic out-patient clinic of the institute.The patients were allocated randomly(flipping-coin simple randomization method)into an intervention group(n=50)and a control group(n=50).Patients in the intervention group received acupressure therapy along with pharmacological treatment.Patients in the control group did not receive acupressure therapy but continued their pharmacological treatment.Changes in pain(visual analog scale,VAS)and QOL(short-form 36-item health survey,SF-36)scores at baseline(A0),during training session(A1),follow-up at the 3rd month after training(A2)and follow-up at the 6th month after training session(A3)were collected and examined.Multiple regression analysis was used to check the relationship between pain and SF-36 domains.Results The VAS score of participants in the intervention group decreased at A3(P=0.001).Scores of physical functioning(PF),role limitations due to emotional problems(RE)and mental health(MH)of SF-36 in the intervention group improved more as compared with the control group.Patients in the intervention group with improvement in VAS(pain)score showed greater changes in mean scores of all domains of SF-36 from baseline(all P<0.05).Except bodily pain(BP),the other domains of SF-36 were negatively correlated with pain score.Conclusion Acupressure therapy with pharmacological treatment can improve health-related QOL and pain among KOA patients.