血清COMP在骨关节炎早期诊断中的作用

摘要

目的:运用血清COMP含量检测从有临床症状而未出现影像学改变的人群中筛选出骨关节炎(osteoarthritis,OA)亚临床患者,从而开展OA的早发现、早治疗.方法:收集2007年8月至2009年9月入院诊断为膝骨关节炎患者或骨关节炎高危人群组115例(OA组),体检健康对照人群35例(健康组).OA组男55例,女60例；年龄39～76岁,平均(55±13.32)岁；体重指数15.1～29.8；病程6～60个月.健康组男16例,女19例；年龄36～77岁,平均(53±12.53)岁；体重指数14.8～29.2.按照国际骨关节炎学会制定的诊断分类标准以及Kellgren和Lawrence衡量标准,确诊OA并分为Ⅰ-Ⅳ级,采用口服塞来昔布胶囊治疗,检测血清COMP含量并分析与OA级别的相关性.OA亚临床组患者随访调查24～38个月,平均33.4个月,检测随访前后的血清COMP含量.结果:健康组血清COMP含量受年龄影响较大(t=2.50,P=0.02),但健康组和OA组均不受性别(t=0.98,P=0.34；t=0.18,P=0.86),体重指数(t=0.56,P=0.92；t=0.17,P=0.85)和吸烟史(t=1.89,P=0.08；t=0.70,P=0.49)影响.随着OA分级的升高,血清COMP含量逐渐升高(F=15.56,P=0.001).即使针对未出现影像学改变的OA亚临床患者,也可以在该患者确诊的2年前检测出显著的血清COMP含量升高,并能有效地将其与其他相关疾病的亚临床患者区分(t=2.55,P =0.03).结论:血清COMP可作为潜在的生物学标记物为膝关节OA的亚临床和早期患者提供新的诊断指标.%Objective: To select sub-clinical patients with symptoms of knee O9teoarthritis (KOA) without X-ray changes by measuring the serum level of cartilage oligomeric matrix protein (COMP) with ELJSA.so as to diagnose and treat patients with knee osteoarthritis at early stage. Methods:The 115 patients with KOA or with symptomatic primary KOA were enrolled from August 2007 to September 2009,which was OA group; and 35 healthy people in the control group. In OA group,there were 55 males and 60 females,ranging in age from 39 to 76 years,with an average of (55*13.32) years; the body mass index (BMI) ranged from 15.1 to 29.8; the disease course ranged from 6 to 60 months. In the control group, there were 16 males and 19 females,ranging in age from 36 to 77 years,with an average of (53?2.53) years; the BMI ranged from 14.8 to 29.2. Patients with symptomatic primary knee OA of Kellgren-Lawrence (K-L) grade I桰V were evaluated. Serum level of COMP and its correlation with OA grade were analyzed by EL1SA method. The patients were treated with Celecoxib capsules. The patients in OA group were followed up,and the duration ranged from 24 to 38 months (averaged ,33.4 months) ,and the serum level of COMP were analyzed before and after treatment. Results .The serum level of COMP in the control group varied with age (<= 2.50,P=0.02). The serum level of COMP did not correlate with gender (control group:l=0.98,P=0.34;OA group: 1=0.18. P= 0.86),BMI (control group:f =0.56,P=0.92; OA group:<=0.17,P=0.85) and smoking (control group:l=l.89,/'=0.08; OA group :t=0.70,P=0.49). The serum level of COMP was higher in the patients with higher K-L grades than in the patients with lower K-L grades (F=15.56,P=0.001) . The sub-clinical KOA patients without X-ray changes can be detected significant higher COMP levels than sub-clinical patients with other diseases (1=2.55,P=0.03). Therefore, according to this method,sub-clinical OA patients can be detected from people with other sub-clinical diseases successfully. Conclusion:The serum level of COMP can be used as a potential prognostic marker to diagnose KOA.