uCTX-Ⅱ在早期骨关节炎诊断及治疗评估中的应用价值研究  

Evaluation of diagnostic and prognostic value of uCTX- Ⅱ in early stage osteoarthritis

作　　者：丁朋[1] 桂鉴超[1] 徐扬[1] 尹昭伟[1] 杨晓斐[1] 蒋逸秋[1] 陈福扬[2] 杨业林[3] 王斌 谭同军 

机构地区：[1]南京医科大学附属南京医院骨科,江苏南京210006 [2]南京市浦口区中心医院骨科,江苏南京211800 [3]南京市江宁医院骨科,江苏南京211100 [4]南京市秦淮医院骨科,江苏南京210006

出　　处：《南京医科大学学报（自然科学版）》2015年第8期1131-1135,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省科教兴卫工程;南京市科委课题(2013sc311011)

摘　　要：目的:观察尿液CTX-Ⅱ(u CTX-Ⅱ)在诊断早期骨关节炎(影像学确诊前期)及评价早期骨关节炎治疗效果中的价值。方法:采用多中心随机双盲对照试验,将参加研究的早期和进展期骨关节炎患者各分为3组,单用氨基葡萄糖、双醋瑞因或联用2种药物的治疗组。在研究进行的开始和第3、6、9、12个月随访,并应用WOMAC评分对患者进行疼痛、僵硬症状和生理功能评分。在研究开始和第6、12个月末留取患者随机尿液,测定u CTX-Ⅱ浓度,并采集正常人群相关数据。结果:在研究的第3个月,各组患者的WOMAC评分总分较初始降低(P<0.05),其中联用治疗组、单用双醋瑞因治疗组低于单用氨基葡萄糖治疗组(P<0.05)。对比早期骨关节炎患者和正常人群u CTX-Ⅱ浓度后,在影像学阴性的早期骨关节炎患者中,u CTX-Ⅱ浓度较正常人高(P<0.05)。将治疗后WOMAC评分下降≥20%视作治疗有效,比较早期骨关节炎组和进展期骨关节炎组中符合这一条件的患者治疗前后u CTX-Ⅱ浓度和WOMAC评分,结果提示两者具有相关性。结论:检测u CTX-Ⅱ浓度简便、易行,可以作为骨关节炎早期诊断的参考指标和评估早期骨关节炎治疗效果的参考指标。早期骨关节炎治疗效果优于进展期患者,早期患者给予软骨营养+保护治疗的方法疗效优于单纯给予一种治疗方法,单用双醋瑞因治疗早期骨关节炎效果优于单用氨基葡萄糖的治疗效果。Objective:To investigate whether the biomarker of u CTX-Ⅱ has a diagnostic and prognostic value in the early stage osteoarthritis or not. Methods:Forty patients with clinical diagnosis of early stage knee osteoarthritis and 35 patients with progression stage osteoarthritis were randomly assigned to receive 1 500 mg of glucosamine daily,100 mg of diacerein daily or both glucosamine and diacerein. Disease symptoms were assessed quarterly by WOMAC scoring. X-ray analysis was performed as baseline. u CTX-Ⅱlevel in urinary were measured as a baseline,6 months,12 months after the initiation of the intervention. The parameters were also corrected for creatinine treatment. Results:A clinically detectable symptomatic benefit was observed as early as 3 months in all groups. In the combined group and the diacerein group,the WOMAC scores decreased singnificantly than that of the glucosamine goup(P < 0.05). The CTX-Ⅱ levels measured in early stage osteoarthritis was significantly higher in urine samples than that from the healthy controls(P < 0.05). A correlation was seen between the u CTX-Ⅱ levers and the WOMAC scores using bivariate analysis.Conclusion:The biomarker of u CTX-Ⅱhad diagnostic and prognostic value in the early stage oteoarthritis. Glucosamine and diacerein alone or combination could reduce pain effectively in the all groups of patients. The combination of glucosamine and diacerein may be more effective.

关 键 词：骨关节炎 氨基葡萄糖 双醋瑞因 uCTX-Ⅱ 

分 类 号：R684.3[医药卫生—骨科学]