骨关节炎与类风湿关节炎患者膝关节滑膜中血管内皮生长因子及血管形态的特征  

Characteristics of vascular morphology and vascular endothelial growth factor in patients with osteoarthritis and rheumatoid arthritis

作　　者：赵绵松[1] 夏蓉晖[1] 王玉华[1] 丁立祥[2] 关雷[3] 黄烽[4] 

机构地区：[1]首都医科大学附属北京世纪坛医院风湿免疫科,北京100853 [2]首都医科大学附属北京世纪坛医院骨科,北京100853 [3]首都医科大学附属北京世纪坛医院麻醉科,北京100038 [4]中国人民解放军总医院风湿科,北京100853

出　　处：《北京大学学报（医学版）》2012年第6期927-931,共5页Journal of Peking University:Health Sciences

基　　金：2008年北京市"十百千"卫生人才培养计划"百"层次项目;北京市卫生局优秀人才A类项目(20081A0303100105);铁道部科技研究开发计划(J2012C002)资助~~

摘　　要：目的:比较骨关节炎(osteoarthritis,OA)患者与类风湿关节炎(rheumatoid arthritis,RA)患者膝关节滑膜组织血管内皮生长因子(vascular endothelial growth factor,VEGF)及滑膜血管形态的特征,分析VEGF与部分炎症指标的相关性。方法:将滑膜组织分为滑膜衬里层、血管周围及衬里下基质组织进行研究,采用原位杂交及免疫组织化学方法检测OA与RA患者膝关节滑膜组织各层VEGF mRNA及蛋白表达。将滑膜组织VEGF蛋白表达的平均光密度比值分别与患者外周血的部分实验室炎性指标进行相关性分析,并将VEGF表达结果进一步与关节镜下滑膜形态学所见进行相关性分析。应用视觉模拟表(visual analog scale,VAS)对关节镜下滑膜形态(血管密度、血管形态、扭曲或直行血管走行方式)进行评分;滑膜增生程度也采取VAS半定量分析方法,分为几乎无滑膜增生、少有、有及滑膜肥厚。结果:在滑膜衬里层、血管周围及衬里下层基质组织,VEGF mRNA及蛋白表达在OA与RA患者之间差异均有统计学意义(P<0.05)。OA衬里下层基质组织VEGF蛋白表达与红细胞沉降率呈正相关(r=0.58,P<0.05);RA滑膜衬里层VEGF蛋白表达与血小板计数呈正相关(r=0.87,P<0.05),RA衬里下层基质组织VEGF蛋白表达与C反应蛋白呈正相关(r=0.56,P<0.05)。此外,OA滑膜衬里层VEGF蛋白表达与直行血管走行方式呈正相关(P<0.05),OA衬里下层基质组织VEGF蛋白表达与滑膜纤维素增生程度呈正相关(P<0.05);RA滑膜衬里层VEGF蛋白表达与血管形态、弯曲血管走行方式及血管密度均呈正相关(P<0.05)。结论:滑膜组织各层VEGF mRNA及蛋白表达在OA及RA患者之间均存在差异,VEGF表达与部分炎症指标及关节镜下滑膜血管形态呈正相关。Objective：To study the differences in vascular morphology and vascular endothelial growth factor（VEGF） of early knee osteoarthritis and rheumatoid arthritis and to evaluate whether VEGF mRNA and VEGF protein expression correlate with disease activity and vascular morphology.Methods：VEGF mRNA and VEGF protein in OA and RA synovium were detected by means of in situ hybridization and immunohistochemistry.Vascular morphology was assessed by arthroscopy.The level of VEGF protein expression of synovium was evaluated to make sure whether it was correlated with disease activity and macroscopic observation by arthroscopy.Results：Significant differences of VEGF mRNA and protein expression were found in synovium lining layer region,perivascular region and sub-lining region between OA and RA.The correlations were found between VEGF expression in sub-lining region and erythrocyte sedimentation rate（ESR） in OA,in synovium lining layer and the counts of platelet in RA,in sub-lining region and C-reaction protein（CRP） in RA.The correlation was found between VEGF expression and synovium lining layer,between VEGF expression and synovial hypertrophy in sub-lining region in OA;The expression of VEGF in synovium lining layer in RA demonstrated its correlation with vascular morphology,tortuous vessels,and vascular density.Conclusion：There is differential VEGF mRNA/VEGF protein expression between OA and RA in each layer of synovial membrane.This phenomenon may be responsible for the pathogenic mechanisms of osteoarthritis and rheumatoid arthritis.

关 键 词：血管内皮生长因子 骨关节炎 关节炎 类风湿 

分 类 号：R593.21[医药卫生—内科学]