摘要
目的分析不同严重程度膝骨关节炎(KOA)患者血清破骨细胞分化因子(RNAKL)、胶原三股螺旋重复蛋白1(CTHRC1)以及骨形态发生蛋白-6(BMP-6)水平变化及其与KOA患者病情严重程度的相关性。方法选取2022年1月至2024年12月南京医科大学附属南京医院(南京市第一医院)康复医学科收治的KOA患者139例纳入KOA亚组,根据患者严重程度分为轻中度KOA亚组(76例)、重度KOA亚组(63例),另选取同时期在本院体检的健康志愿者61例作为健康对照组。采用酶联免疫吸附法(ELISA)检测血清中RNAKL、CTHRC1、BMP-6水平;视觉模拟评分(VAS)评价KOA患者膝关节的疼痛程度;美国膝关节协会评分(KSS)评价KOA患者膝关节功能;Pearson与Spearman法分析血清RNAKL、CTHRC1、BMP-6水平与病情严重程度、VAS评分、KAA评分的相关性;多因素Logistic回归模型分析KOA患者病情发展的影响因素;并对KOA亚组患者进行2月的运动康复治疗,比较干预前后RNAKL、CTHRC1、BMP-6水平变化。结果重度KOA亚组血清RNAKL、CTHRC1、BMP-6水平高于轻中度KOA亚组与健康对照组(F/P=840.972/<0.001、217.364/<0.001、64.188/<0.001);运动康复治疗后KOA患者血清RNAKL、CTHRC1、BMP-6水平较运动康复治疗前均有所降低(t/P=26.287/<0.001、55.54/<0.001、15.497/<0.001);重度KOA亚组高劳动强度患者占比、VAS评分大于轻中度KOA亚组,KSS评分则小于轻中度KOA亚组(χ^(2)/t/P=12.071/0.002、5.350/<0.001、35.157/<0.001);血清RNAKL、CTHRC1、BMP-6水平与病情严重程度以及VAS评分呈正相关,与KSS评分呈负相关(r/P=0.437/<0.001、0.455/<0.001、-0.462/<0.001,0.439/<0.001、0.471/<0.001、-0.446/<0.001,0.512/<0.001、0.498/<0.001、-0.523/<0.001);RNAKL、CTHRC1、BMP-63者以及劳动强度均是重度KOA发生的独立风险因素[OR(95%CI)=2.376(1.792~3.151)、2.711(1.861~3.950)、3.015(2.002~4.541)、2.634(1.399~4.961)]。结论血清RNAKL、CTHRC1、BMP-6在KOA患者血清中升高,与病情严重程度、VAS评分以及KSS评分密切相关。经运动康复治疗后3者水平均有所降低,可能通过此途径改善KOA患者的症状,减缓病情进展。
Objective To analyze the change patterns in serum receptor activator of nuclear factor-κB ligand(RNAKL),collagen triple helix repeat containing protein 1(CTHRC1),and bone morphogenetic protein-6(BMP-6)in patients with knee osteoarthritis(KOA)with different severities,and to evaluate the correlation between these three markers and the severity of KOA patients.Methods From January 2022 to December 2024,139 KOA patients admitted to our hospital were included in the study and classified into mild to moderate KOA group(76 cases)and severe KOA group(63 cases)complying with their severities.Additionally,61 healthy volunteers who underwent physical examinations were designated as normal group.Enzyme linked immunosorbent assay(ELISA)was applied to detect RNAKL,CTHRC1,and BMP-6 in serum samples.Visual Analogue Scale(VAS)was used to evaluate the degree of knee joint pain in KOA.The Knee Society Score(KSS)was used to assess knee joint function in KOA.Pearson and Spearman methods were performed to evaluate the correlation between serum RNAKL,CTHRC1,BMP-6 and disease severity,VAS score,and KAA score.Multiple logistic regression model was utilized to identify the influencing factors of the development of KOA condition.Patients from the KOA group were also subjected to exercise rehabilitation for 2 months,and the changes of RNAKL,CTHRC1,and BMP-6 levels were compared before and after the intervention.Results The severe KOA group showed significantly higher serum RNAKL,CTHRC1,and BMP-6 than the mild to moderate KOA group and the normal group(F/P=840.972/<0.001,217.364/<0.001,64.188/<0.001).Furthermore,the serum RNAKL,CTHRC1,and BMP-6 levels of KOA patients were significantly lowered after exercise rehabilitation treatment compared with those before exercise rehabilitation treatment(P<0.05)(t/P=26.287/<0.001,55.54/<0.001,15.497/<0.001).The severe KOA group had a significantly higher proportion of patients with great labor intensity and VAS score than the mild to moderate KOA group(P<0.05),and significantly smaller KSS score than mild to moderate KOA group(χ^(2)/t/P=12.071/0.002,5.350/<0.001,35.157/<0.001).Serum RNAKL,CTHRC1,and BMP-6 were positively correlated with the severity of the disease and VAS score(P<0.05),while negatively correlated with KSS score(r/P=0.437/<0.001,0.455/<0.001,-0.462/<0.001;0.439/<0.001,0.471/<0.001,-0.446/<0.001;0.512/<0.001,0.498/<0.001,-0.523/<0.001).RNAKL,CTHRC1,BMP-6,and labor intensity were all independent risk factors for severe KOA[OR(95%CI)=2.376(1.792-3.151),2.711(1.861-3.950),3.015(2.002-4.541),2.634(1.399-4.961)].Conclusion Serum RNAKL,CTHRC1,and BMP-6 are elevated in KOA patients.These three markers are closely related to the severity of the condition,VAS score,and KSS score.After exercise rehabilitation treatment,levels of all three decrease,which could improve the symptoms of KOA patients through this approach and slow down the progress of the disease.
作者
王琪
李雪萍
康海燕
叶子琦
WANG Qi;LI Xueping;KANG Haiyan;YE Ziqi(Department of Rehabilitation Medicine,Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital),Nanjing 210006,China)
出处
《标记免疫分析与临床》
2025年第7期1408-1413,共6页
Labeled Immunoassays and Clinical Medicine
关键词
膝骨关节炎
破骨细胞分化因子
胶原三股螺旋重复蛋白1
骨形态发生蛋白-6
运动疗法
Knee osteoarthritis
Receptor activator of nuclear factor-κB ligand
Collagen triple helix repeat containing protein 1
Bone morphogenetic protein-6
Physical therapy
