标题：膝骨关节炎患者血浆硬化蛋白和关节液YKL-40的水平及临床意义

      作者：齐亮 1，秦妮 2，赵赞栋 3    1.西安交通大学附属红会医院中西医结合骨科，陕西 西安 710054；2.西安市中心医院重症医学科，陕西 西安 710000；3.西安交通大学附属红会医院手外科，陕西 西安 710054

      卷次： 2019年30卷21期

      【摘要】 目的 探究膝骨关节炎(KOA)患者血浆硬化蛋白(SOST)、关节液甲壳质酶(YKL-40)的水平及其临床意义。方法 选取2016年8月至2018年8月西安交通大学附属红会医院收治的54例KOA患者(观察组)和同期因外伤导致膝关节损伤的患者54例(对照组)作为研究对象，观察组按照K-L分级标准分为轻、中、重三组，其中轻度组(n=19)为 0~Ⅰ级，中度组(n=22)为Ⅱ级，重度组(n=13)为Ⅲ~Ⅳ级。比较各组受检者血浆 SOST水平、关节液YKL-40水平，并分析血浆SOST、关节液YKL-40水平与KOA的关系。结果 观察组中的轻度、中度、重度三组患者的血浆 SOST水平均明显低于对照组[(1 046.82±193.18) pg/mL、(878.13±184.92) pg/mL、(701.66±163.24) pg/mLvs (1 236.52±231.65) pg/mL]，差异有统计学意义(P<0.05)，且重度组患者的血浆SOST水平低于中度组，中度组血浆SOST水平低于轻度组，差异均有统计学意义(P<0.05)；观察组中的轻度、中度、重度三组患者的关节液YKL-40水平明显高于对照组[(1 137.84±124.65) μg/L、(1 567.64±146.30) μg/L、(1 986.42±214.72) μg/L vs (1 038.87±108.33) μg/L]，差异均有统计学意义(P<0.05)，且重度组患者关节液 YKL-40水平明显高于中度组，中度组又明显高于轻度组，差异均有统计学意义(P<0.05)；血浆 SOST水平与KOA程度呈显著负相关(r= -0.700，P<0.01)，关节液 YKL-40与KOA程度呈显著正相关(r=0.928，P<0.01)；ROC曲线分析结果显示，血浆SOST与关节液YKL-40均具有诊断价值，其中，血浆 SOST的AUC为 0.906、Cut-off值为 1 065.59 μg/L，敏感性为 92.60%，特异性为 77.80%，Youden指数为0.704；关节液 YKL-40的AUC为0.942、Cut-off值为1 171.37 pg/mL，敏感性为79.60%，特异性为96.30%，Youden指数为0.759。结论 KOA患者血浆SOST与关节炎严重程度呈显著负相关，关节液YKL-40水平与关节炎严重程度呈显著正相关，且可作为评估KOA的生物标记物。
      【关键词】 膝骨关节炎；血浆硬化蛋白；关节液；甲壳质酶；临床意义
      【中图分类号】 R684.3 【文献标识码】 A 【文章编号】 1003—6350（2019）21—2758—04

Levels of plasma sclerostin and synovial fluid YKL-40 in patients with knee osteoarthritis and their clinicalsignificance.
QI Liang 1, QIN Ni 2, ZHAO Zan-dong 3. 1. Orthopaedic Department of Integrated Traditional Chinese andWestern Medicine, Honghui Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710054, Shaanxi, CHINA; 2. Departmentof Critical Care Medicine, Xi'an Central Hospital, Xi'an 710000, Shaanxi, CHINA; 3. Department of Hand Surgery, HonghuiHospital Affiliated to Xi'an Jiaotong University, Xi'an 710054, Shaanxi, CHINA
【Abstract】 Objective To explore the levels of plasma sclerostin (SOST) and synovial fluid chitinase-3-likeprotein (YKL-40) in patients with knee osteoarthritis (KOA) and their clinical significance. Methods From August2016 to August 2018, 54 patients with KOA (observation group) and 54 patients with knee joint injury caused by trauma(control group) admitted to the Honghui Hospital Affiliated to Xi'an Jiaotong University were selected as subjects. Theobservation group was divided into three sub-groups according to the K-L classification criteria: grade 0 and Ⅰ as mildgroup (n=19), grade Ⅱ as moderate group (n=22), and grade Ⅲ and Ⅳ as severe group (n=13). The levels of SOST inplasma and YKL-40 in synovial fluid were compared in each group, and the relationship were analyzed between the lev-els of SOST in plasma and YKL-40 in synovial fluid with KOA. Results The plasma SOST level of the observationgroup was (1 046.82±193.18) pg/mL in the mild group, (878.13±184.92) pg/mL in the moderate group, and (701.66±163.24) pg/mL in the severe group, which was respectively lower than (1 236.52±231.65) pg/mL of the control group (P<0.05). The plasma SOST level was lower in the severe group than in the moderate group, and the plasma SOST level waslower in the moderate group than in the mild group (P<0.05). The level of YKL-40 in synovial fluid was (1 137.84±124.65) μg/L in the mild group, (1 567.64±146.30) μg/mL in the moderate group, and (1 986.42±214.72) μg/mL in the se-vere group, which was respectively lower than (1 038.87±108.33) μg/mL of the control group (P<0.05). The level ofYKL-40 in synovial fluid was significantly higher in the severe group than in the moderate group, and the level washigher in the moderate group than in the mild group (P<0.05). The level of plasma SOST was negatively correlated withthe KOA degree (r=-0.700, P<0.05), and YKL-40 in synovial fluid was positively correlated with KOA degree (r=0.928,P<0.05). The results of ROC curve analysis showed that plasma SOST and synovial fluid YKL-40 had diagnostic value.