骨关节炎患者血清及关节液中TNF-α与MMP-3含量及临床意义

目的研究膝关节骨关节炎患者血清及关节液中TNF-α与MMP-3含量与骨关节炎的病变严重程度的关系,及二者在血清及关节液中水平的相关性,探讨TNF-α与MMP-3在骨关节炎发病中的作用及其在临床上反映骨性关节炎（OA）病程变化的可靠性。方法对123例骨性关节炎患者及28名正常人分别拍摄双侧单足站立位膝关节X线片。根据X线片将膝关节骨关节炎患者分早、中、晚3期。正常人及患者均抽取静脉血和膝关节液,离心后取上清液。用夹心酶联免疫吸附法测定血清及关节液样本中TNF-α与MMP-3含量。结果膝关节骨关节炎患者血清中TNF-α与MMP-3含量高于正常人,差异有显著性（P〈0.001）。膝关节骨关节炎患者血清中TNF-α和MMP-3水平在早期已明显增高,而晚期水平达到最高,而且随着病情的加重,含量明显增高;关节液中TNF-α和MMP-3的含量同样随着病情的加重而增高。研究结果还显示,骨关节炎患者血清与关节液中TNF-α和MMP-3水平分别作相关性分析,结果表明存在线性相关：rTNF-α=0.69（P〈0.001）,rMMP-3=0.74（P〈0.001）;同时TNF-α与MMP-3两者含量在血清中和在关节液中同样存在线性相关性。结论TNF-α与MMP-3在骨关节炎患者血清与关节液中均有较高水平,并与关节病变严重程度相关,它们在患者血清与关节液中的水平存在相关性。因此,联合检测TNF-α与MMP-3在OA关节液和血液中的含量,有助于病情的判断。

Content and Clinical Significance of TNF-α and MMP-3 in Serum and Synovial Fluid in Osteoarthritis Patients

Objective To study the levels of urokinase-type plasminogen activator （uPA） and its receptor （uPAR） in synovial fluid and plasma of patients with OA and its relationgship with the pathological changes extent of OA,and their dependability in synovial fluid and plasma, so as to investigate its effect and reliability in OA. Methods Shooting the two knee joint X-ray in monopodial standing position for 123 OA patients and 28 control group patients,and distinguishing early,middling and late stage for the OA patients according to the X-ray. Venous blood and synovial fluid of knee joint was drown off from OA patients and control group patients,then the venous blood and synovial fluid was centrifugated. ELISA sandwich method was used to measure the levels of TNF-α and MMP-3 in venous blood and synovial fluid. Resuits The level of TNF-α and MMP-3 in serum of OA patients was higher than that in control group patients, the difference has significance（P〈0. 001）. The level of TNF-α and MMP-3 in serum of OA patients was higher than that in control group patients in early stage, and the level achieved highest in late stage, and along with the aggravation of pathogenetic condition,the levels raise up obviously,and dependability analysis demonstrated that the levels of TNF-α and MMP-3 in venous blood and synovial fluid of OA patients exist linear correlation, rTNF-α = 0. 69 （P〈0. 001 ）, rMMP3 =0. 74 （P〈0. 001 ） ; and at the same time,the contents of TNF-α and MMP-3 in venous blood and synovial fluid also exist linear correlation. Conclusion The levels of TNF-α and MMP-3 in venous blood and synovial fluid are all high in OA patients,and exist correlation with graveness extent of arthropathy,and their level in venous blood and synovial fluid exist correlation. The contents of TNF-α and MMP-3 in venous blood and synovial fluid make for the iudgement of pathogenetic condition.