自体富血小板血浆对骨关节炎患者LXA4和p65-RelA的影响

doi:10.3760/cma.j.issn.1007-1245.2024.22.015

摘要/Abstract

摘要：

目的　研究自体富血小板血浆（PRP）在骨关节炎（OA）患者中的临床效果，以及对患者脂氧素A4（LXA4）、核因子蛋白p65（p65-RelA）的影响。方法　选取延安大学附属医院2022年10月至2023年4月收治的早、中期OA患者157例为研究对象，根据治疗方法分为两组。观察组81例接受PRP治疗，其中男54例、女27例，年龄（67.78±8.86）岁。对照组76例接受医用几丁糖治疗，其中男53例、女23例，年龄（67.59±9.17）岁。两组均连续治疗12个月。比较两组治疗前后的Lysholm评分、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、最大膝关节活动度（ROM），以及骨代谢水平、血清炎症因子、LXA4、糖蛋白唾液凝集素（DMBT）含量。统计学方法采用t检验、秩和检验、χ²检验。结果　治疗12个月后，两组WOMAC评分均低于治疗前，Lysholm评分与ROM均高于治疗前，且观察组各指标均优于对照组［（33.71±8.55）分比（46.75±9.78）分、（80.10±9.54）分比（75.48±9.04）分、（118.61±10.21）°比（89.21±9.04）°］，差异均有统计学意义（t=-8.91、3.11、19.06，均P<0.05）；两组患者骨钙素（BGP）水平均高于治疗前，Ⅰ型原胶原N-端前肽（PINP）、Ⅰ型胶原交联C-末端肽（CTX）、甲状旁腺素（PTH）水平均低于治疗前，且观察组各指标水平均优于对照组［（19.74±2.54）μg/L比（15.64±2.17）μg/L、（24.68±8.71）μg/L比（30.68±9.04）μg/L、（9.78±1.04）μg/L比（12.47±1.15）μg/L，（3.74±0.29）pmol/L比（4.23±0.36）pmol/L］，差异均有统计学意义（t=10.84、-4.24、-15.39、-9.42，均P<0.05）；两组患者LXA4水平均高于治疗前，白细胞介素（IL）-1β、肿瘤坏死因子（TNF）-α、IL-17、基质金属蛋白酶（MMP）、p65-RelA mRNA、DMBT水平均低于治疗前，且观察组各指标水平均优于对照组，差异均有统计学意义（t=6.59、-9.99、-3.36、-19.20、-11.85、-14.71、-9.95，均P<0.05）。结论　PRP可改善OA患者治疗效果，提高骨代谢中骨形成水平，增加LXA4含量，下调p65-RelA表达水平，降低炎症反应。

关键词:

骨关节炎, 富血小板血浆, 脂氧素A4, 核因子蛋白p65, 临床效果

Abstract:

Objective　To investigate the clinical effect of autologous platelet-rich plasma in the treatment of osteoarthritis (OA) and its effect on lipoxin A4 (LXA4) and nuclear factor-κB P65 protein (p65-RelA). Methods　A total of 157 cases of early and middle stage OA patients admitted to Yan'an University Affiliated Hospital from October 2022 to April 2023 were collected as the research objects and were divided into two groups according to the treatment methods. Eighty-one patients in the observation group received autologous platelet-rich plasma therapy, including 54 males and 27 females, aged (67.78±8.86) years; 76 patients in the control group received medical chitin treatment, including 53 males and 23 females, aged (67.59±9.17) years. Both groups were treated continuously for 12 months. The Lysholm score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), maximum knee range of motion (ROM), bone metabolism level, serum inflammatory factors, LXA4, and glycoprotein salivary lectin (DMBT) contents were compared between the two groups before and after treatment. t test, rank sum test, and χ² test were used. Results　After 12 months of treatment, the WOMAC scores in both groups were lower than those before treatment, and the Lysholm scores and ROM were higher than those before treatment; all the indexes in the observation group were better than those in the control group [(33.71±8.55) points vs. (46.75±9.78) points, (80.10±9.54) points vs. (75.48±9.04) points, (118.61±10.21)° vs. (89.21±9.04)°], with statistically significant differences (t=-8.91, 3.11, and 19.06, all P<0.05). After 12 months of treatment, the levels of osteocalcin (BGP) in both groups were higher than those before treatment, and the levels of type Ⅰ procollagen N-terminal peptide (PINP), type Ⅰ collagen cross-linked C-terminal peptide (CTX), and parathyroid hormone (PTH) were lower than those before treatment; the levels of all the indexes in the observation group were better than those in the control group [(19.74±2.54) μg/L vs. (15.64±2.17) μg/L, (24.68±8.71) μg/L vs. (30.68±9.04) μg/L, (9.78±1.04) μg/L vs. (12.47±1.15) μg/L, (3.74±0.29) pmol/L vs. (4.23±0.36) pmol/L], with statistically significant differences (t=10.84, -4.24, -15.39, and -9.42, all P<0.05). After 12 months of treatment, the levels of LXA4 in both groups were higher than those before treatment, and the levels of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-17, matrix metalloproteinase (MMP), p65-RelA mRNA, and DMBT were lower than those before treatment; the levels of all the indexes in the observation group were better than those in the control group, with statistically significant differences (t=6.59, -9.99, -3.36, -19.20, -11.85, -14.71, and -9.95, all P<0.05). Conclusion　Autologous platelet-rich plasma can improve the therapeutic effect of OA patients, increase the level of bone formation in bone metabolism, increase the content of LXA4, down-regulate the expression level of p65-RelA, and reduce the inflammatory response of OA.

Key words:

Osteoarthritis, Platelet-rich plasma, Lipoxin A4, Nuclear factor-κB P65 protein, Clinical effect

常宝生刘治桓赵程锦.

自体富血小板血浆对骨关节炎患者LXA4和p65-RelA的影响 [J]. 国际医药卫生导报, 2024, 30(22): 3764-3769.

Chang Baosheng, Liu Zhihuan, Zhao Chengjin.

Effect of autologous platelet-rich plasma on LXA4 and p65-RelA in patients with osteoarthritis [J]. International Medicine and Health Guidance News, 2024, 30(22): 3764-3769.

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