肩关节组织和滑液生长素释放肽信使核糖核酸和蛋白表达与肩袖撕裂和冻结肩严重程度的相关性研究

目的探讨肩关节组织和滑液生长素释放肽(Ghrelin)信使核糖核酸(mRNA)和蛋白表达与肩袖撕裂(RCT)和冻结肩(FS)严重程度的相关性。方法收集2018年1月到2019年9月广东省惠州市第一人民医院骨科诊断为RCT和FS的患者各66例(分别设为RCT组和FS组),另外选取诊断为肩关节前向不稳的患者60例作为对照组。应用超声影像学对RCT严重程度进行判定,RCT组患者根据RCT严重程度分为3个亚组:巨大全层撕裂(MFTT)组23例,非巨大全层撕裂(NMFTT)组23例和部分厚度撕裂(PTT)组20例。FS组患者根据FS的经典分期方法可分为:急性期31例,粘连期35例。收集肩关节囊组织样本及肩关节滑液,采用逆转录-聚合酶链反应(RT-PCR)检测组织样本中生长素释放肽mRNA的表达量,酶联免疫吸附测定(ELISA)检测关节滑液生长素释放肽的表达。采用视觉模拟评分法(VAS)评分和Constant-Murley功能评分对患者疼痛和肩关节症状功能进行评定。结果RCT组、FS组和对照组3组患者性别比、年龄等差异无统计学意义(P>0.05),具有可比性。RCT组和FS组患者肩关节囊组织中的生长素释放肽mRNA表达和肩关节滑液相中生长素释放肽蛋白水平对于对照组患者均显著降低,差异均有统计学意义(P<0.05)。在RCT患者中,PTT亚组肩关节囊生长素释放肽mRNA表达和肩关节滑液生长素释放肽蛋白水平表达均最高,随后依次是NMFTT亚组与MFTT亚组,以上项目3组间比较差异均有统计学意义(P<0.05)。急性期FS患者肩关节囊生长素释放肽mRNA表达和肩关节滑液生长素释放肽蛋白水平均显著低于黏连期患者,差异均有统计学意义(P<0.05)。RCT患者和FS患者肩关节囊组织生长素释放肽mRNA相对表达量和肩关节滑液生长素释放肽蛋白表达水平与VAS评分和白细胞介素-6(IL-6)水平均呈负相关性(P<0.05),与Constant-Murley评分均呈正相关性(P<0.05)。结论肩关节组织和滑液生长素释放肽mRNA和蛋白表达与RCT患者和FS患者病情进展呈显著负相关性,局部补充生长素释放肽可能可以作为治疗RCT患者和FS患者的潜在方法。

Correlation of mRNA and protein levels of Ghrelin in shoulder tissue and synovial fluid with severity of rotator cuff tear and frozen shoulder

Objective To investigate the correlation of mRNA and protein levels of Ghrelin in shoulder tissue and synovial fluid with severity of rotator cuff tear(RCT)and frozen shoulder(FS).Methods Recruited for this study were 66 RCT and 66 FS patients who had been definitely diagnosed at Department of Orthopedics,The First Hospital of Huizhou from January 2018 to September 2019.Another 60 patients with rotator instability were recruited as a control group.After the severity of RCT was evaluated by ultrasonographic images,the RCT group was further divided into 3 subgroups according to the severity of RCT:a massive full thickness tear(MFTT)subgroup,a non massive full thickness tear(MFTT)subgroup,and a partial thickness tear(PTT)subgroup.The FS group was conventionally divided into 31 cases of acute phase and 35 cases of adhesive phase.Samples of subacromial bursa and shoulder joint bursa tissues and shoulder joint synovial fluid were collected.The expression of Ghrelin mRNA was detected by RT-PCR and the expression of Ghrelin protein in joint synovial fluid was detected by ELISA.The symptoms and functions of shoulder joint were evaluated by visual analogue scale(VAS)and Constant-Murley functional score.Results There were no significant differences in gender or age between the RCT,FS and control groups,showing compatibility(P>0.05).The expression of Ghrelin mRNA in subacromial synovial capsule and shoulder joint capsule and the expression of Ghrelin protein in shoulder synovial fluid in the RCT and FS groups were significantly lower than those in the control group(P<0.05).The expression of Ghrelin mRNA in subacromial synovial capsule and shoulder joint capsule and the expression of Ghrelin protein in shoulder synovial fluid in the PTT subgroup were the highest,followed sequentially by NMFTT and MFTT subgroups,with significant differences between subgroups(P<0.05).For FS patients,the expression levels of Ghrelin mRNA and protein in the acute phase were significantly lower than in the adhesive phase(P<0.05).The relative expression of Ghrelin mRNA in joint capsule and the expression of Ghrelin protein in shoulder synovial fluid were negatively correlated with VAS scores and IL-6 levels(all P<0.05),and positively correlated with the Constant-Murley scores(all P<0.05).Conclusions The expression of Ghrelin in shoulder tissue and synovial fluid is negatively correlated with the progress of rotator cuff tear and frozen shoulder.Local supplementation of Ghrelin may be a potential therapy for rotator cuff tear and frozen shoulder.