Abstract:

Objective　To investigate the value of serum levels of cartilage oligomeric matrix protein (COMP), C-terminal telopeptide of type Ⅱ collagen (CTX-Ⅱ), and soluble vascular cell adhesion molecule-1 (sVCAM-1) in the prediction of prognosis of patients with knee osteoarthritis (KOA) after joint arthroplasty. Methods　The clinical data of 120 patients with KOA undergoing joint arthroplasty at Xi'an International Medical Center Hospital from January 2023 to August 2024 were retrospectively analyzed. Among them, there were 71 males and 49 females, with an age of (62.55 ± 5.67) years. All the patients were assessed using the Lysholm Knee Score (LKS). Based on the assessment scores 6 months after the surgery, the patients were divided into a good prognosis group (LKS≥70; 92 cases) and a poor prognosis group (LKS <70; 28 cases). The data were collected and compared between the two groups. Receiver operating characteristic (ROC) curves were plotted, and the areas under the curves (AUC) were calculated to evaluate the predictive values of serum COMP, CTX-Ⅱ, and sVCAM-1 levels for postoperative prognosis. Statistical comparisons were conducted using t and χ² tests. Results　There were no statistical differences between the two groups in the terms of gender, age, body mass index, surgical test, American Society of Anesthesiologists (ASA) grade, Association Research Circulation Osseous (ARCO) stage, history of alcohol consumption, history of smoking, diabetes, and hypertension (all P>0.05). The levels of COMP, CTX-Ⅱ, and sVCAM-1 in the good prognosis group were lower than those in the poor prognosis group [(475.81±74.52) ng/L vs. (523.96±74.14) ng/L, (1 005.21±105.99) ng/L vs. (1 070.12±115.67) ng/L, and (43.17±6.59) nmol/L vs. (72.21±6.96) nmol/L], with statistical differences (all P<0.05). The results of logistic regression analysis showed that COMP≥492.51 ng/L, CTX-Ⅱ≥1 040.02 ng/L, and sVCAM-1≥58.41 nmol/L were the independent risk factors affecting the patients' poor prognosis (all P<0.05). The ROC analysis showed that the AUC's of COMP≥492.51 ng/L, CTX-Ⅱ≥1 040.02 ng/L, and sVCAM-1≥58.41 nmol/L in the prediction the patients' prognosis were 0.825, 0.795, and 0.833,  respectively; the AUC of the combination of the three was 0.924, with a sensitivity of 85.84% and a specificity of 86.48%. Conclusions　The serum levels of COMP, CTX-Ⅱ, and sVCAM-1 are valuable for dynamically assessing prognosis of patients with KOA after joint arthroplasty. Their combination may more effectively predict the poor prognosis.

Key words:

Knee osteoarthritis, Joint arthroplasty, Cartilage oligomeric matrix protein, Type Ⅱ , collagen C-terminal telopeptide, Soluble vascular cell adhesion molecule-1, Prognosis

摘要：

目的　探讨血清软骨寡聚基质蛋白（COMP）、Ⅱ型胶原C-端肽（CTX-Ⅱ）、可溶性血管细胞黏附分子-1（sVCAM-1）水平对膝骨关节炎患者关节置换术后预后的预测价值。方法　采用回顾性分析，选取2023年1月至2024年8月在西安国际医学中心医院接受关节置换术治疗的膝骨关节炎患者120例，其中男71例，女49例，年龄（62.55±5.67）岁。均行Lysholm膝关节功能评分（LKS）评估，根据术后6个月评估得分结果分为两组，LKS≥70分为预后良好组（92例），LKS<70分为预后不良组（28例）。收集并比较两组患者资料，绘制受试者操作特征曲线（ROC），计算曲线下面积（AUC）评估血清COMP、CTX-Ⅱ、sVCAM-1水平对膝骨关节炎患者关节置换术后预后的预测价值，采用t检验、χ²检验进行统计比较。结果　两组性别、年龄、体重指数、手术侧别、美国麻醉医师协会分级、国际骨循环研究学会分期、饮酒史、吸烟史、糖尿病、高血压比较，差异均无统计学意义（均P>0.05）。预后良好组COMP、CTX-Ⅱ、sVCAM-1水平分别为（475.81±74.52）ng/L、（1 005.21±105.99）ng/L、（43.17±6.59）nmol/L，显著低于预后不良组的（523.96±74.14）ng/L、（1 070.12±115.67）ng/L、（72.21±6.96）nmol/L，差异均有统计学意义（均P<0.05）。Logistic回归分析结果显示，COMP≥492.51 ng/L、CTX-Ⅱ≥1 040.02 ng/L、sVCAM-1≥58.41 nmol/L均为影响膝骨关节炎患者关节置换术后预后不良的独立危险因素（均P<0.05）。ROC分析，COMP≥492.51 ng/L、CTX-Ⅱ≥1 040.02 ng/L、sVCAM-1≥58.41 nmol/L预测膝骨关节炎患者关节置换术后预后的AUC分别为0.825、0.795、0.833，三者联合预测的AUC为0.924，灵敏度和特异度最佳，分别为85.84%、86.48%。结论　血清COMP、CTX-Ⅱ、sVCAM-1水平有助于动态评估膝骨关节炎患者关节置换术后预后情况，联合检测能更有效地预测患者预后不良风险。

关键词:

膝骨关节炎, 关节置换术, 血清软骨寡聚基质蛋白, Ⅱ型胶原C-端肽, 可溶性血管细胞黏附分子-1, 预后