膝骨关节炎不同中医辨证分型与关节液中炎性因子及基质金属蛋白酶表达的相关性研究  

Correlations between different TCM differentiation syndrome types of knee osteoarthritis and expressionsof matrix metalloproteinases and inflammatory factors in joint fluid

作　　者：郭佳军 王守国 王世杰 刘昕 马红娥 张文贤 GUO Jiajun;WANG Shouguo;WANG Shijie;LIU Xin;MA Honge;ZHANG Wenxian(Clinical College of Traditional Chinese Medicine,Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China;The Affiliated Hospital of Gansu University of Chinese Medicine,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃中医药大学中医临床学院,甘肃兰州730000 [2]甘肃中医药大学附属医院,甘肃兰州730000

出　　处：《现代中西医结合杂志》2024年第10期1338-1343,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：国家自然科学基金资助项目(82060877);兰州市人才创新创业项目(2021-RC-113);甘肃省药品监督管理局科研项目(2023GSMPA029);甘肃省自然科学基金资助项目(23JRRA1583)。

摘　　要：目的 探讨膝骨关节炎(KOA)患者不同中医辨证分型与关节液中炎性因子及基质金属蛋白酶表达的相关性。方法 选取2021年12月—2022年10月在甘肃省中医院关节骨科住院的KOA患者50例,根据中医辨证分型分为气滞血瘀证、湿热痹阻证、寒湿痹阻证、肝肾亏虚证、气血虚弱证,每个证型10例。通过双抗体夹心酶联免疫吸附法检测各证型患者膝关节液中炎性因子[白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]、基质金属蛋白酶[基质金属蛋白酶-1(MMP-1)、基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-3(MMP-3)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶-13(MMP-13)]水平,并采用Spearmen法分析不同证型与各炎症因子及基质金属蛋白酶水平的相关性。结果 气滞血瘀证、湿热痹阻证患者关节液中IL-1β、IL-6、TNF-α、MMP-9、MMP-13水平均明显高于寒湿痹阻证、肝肾亏虚证、气血虚弱证患者(P均<0.05),湿热痹阻证患者关节液中MMP-1水平明显高于气滞血瘀证、肝肾亏虚证、气血虚弱证患者(P均<0.05)。气滞血瘀证、湿热痹阻证与IL-1β、IL-6、TNF-α水平均呈正相关(r=0.385,0.492,0.334,0.655,0.537,0.584,P均<0.05),寒湿痹阻证与TNF-α水平呈负相关(r=-0.284,P<0.05),肝肾亏虚证、气血虚弱证与IL-1β、IL-6、TNF-α水平均呈负相关(r=-0.447,-0.471,-0.237,-0.506,-0.350,-0.397,P均<0.05)。气滞血瘀证与MMP-9、MMP-13水平呈正相关(r=0.485,0.411,P均<0.05),湿热痹阻证与MMP-1、MMP-9、MMP-13水平呈正相关(r=0.672,0.541,0.613,P均<0.05),肝肾亏虚证、气血虚弱证与MMP-1、MMP-9、MMP-13水平呈负相关(r=-0.319,-0.392,-0.461,-0.407,-0.388,-0.485,P均<0.05)。结论 KOA不同中医证型患者间关节液中炎性因子和基质金属蛋白酶水平有一定差异,且中医分型与关节液中炎性因子及基质金属蛋白酶水平存在一定相关性,这些指标可作为KOA中医辨证论治的辅助指标,为�Objective It is to explore the correlations between different traditional Chinese medicine(TCM)syndrome differentiation types and expressions of matrix metalloproteinases and inflammatory factors in joint fluid in patients with knee osteoarthritis(KOA).Methods Fifty KOA patients hospitalized in the Orthopedics Department of Gansu Provincial Hospital of Traditional Chinese Medicine from December 2021 to October 2022 were selected,and they were divided into Qi-stagnation and blood stasis group,damp-heat impediment obstruction group,cold-dampness impediment obstruction group,liver and kidney deficiency group and Qi-blood deficiency group according to TCM syndrome differentiation,with 10 cases in each group.The levels of inflammatory factors[interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],matrix metalloproteinases[matrix metalloproteinase-1(MMP-1),matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-3(MMP-3),matrix metalloproteinase-9(MMP-9),and matrix metalloproteinase-13(MMP-13)]in the knee joint fluid of patients of each syndrome type were detected by double-antibody sandwich enzyme-linked immunosorbent assay,and the correlations between different syndrome types and levels of matrix metalloproteinases and inflammatory factors were analyzed by Spearmen method.Results The expression levels of IL-1β,IL-6,TNF-α,MMP-9 and MMP-13 in joint fluid of patients with syndrome of Qi-stagnation and blood-stasis and syndrome of damp-heat impediment obstruction were obviously higher than those of patients with syndrome of cold-dampness impediment obstruction,syndrome of liver-kidney deficiency and syndrome of Qi-blood deficiency(all P<0.05),the expression level of MMP-1 in joint fluid of patients with syndrome of damp-heat impediment obstruction was obviously higher than that of patients with syndrome of Qi-stagnation and blood stasis,syndrome of liver-kidney deficiency and syndrome of Qi-blood deficiency(all P<0.05).Syndrome of Qi stagnation and blood stasis,syndrome of damp-heat impediment

关 键 词：膝骨关节炎 中医证型 炎性因子 基质金属蛋白酶 关节液 

分 类 号：R684.3[医药卫生—骨科学]