中国修复重建外科杂志

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关节腔注射富血小板血浆对膝骨关节炎患者关节液及血浆中 IL-17 的影响

张海森 1 , 白玉明 1 , , 刘畅 1 , 靳胜利 1 , 苏珂 1 , 刘颖 2 , 吕志昌 3

1. 沧州市中心医院骨二科（河北沧州 061001） ;
2. 沧州市人民医院手术室（河北沧州   061001） ;
3. 献县人民医院骨科（河北献县   062250）

收稿日期: 2017-04-04;  修回日期:2017-06-25; 

通讯作者: 白玉明, Email: 315097190@qq.com

Effect of intra-articular injection of platelet-rich plasma on interleukin-17 expression in synovial fluid and venous plasma of knee osteoarthritis patients

ZHANG Haisen 1 , BAI Yuming 1 , , LIU Chang 1 , JIN Shengli 1 , SU Ke 1 , LIU Ying 2 , LÜ Zhichang 3

1. No.2 Department of Orthopaedics, Central Hospital of Cangzhou, Cangzhou Hebei, 061001, P.R.China ;
2. Operation Room, People’s Hospital of Cangzhou, Cangzhou Hebei, 061001, P.R.China ;
3. Derpatment of Orthopaedics, People’s Hospital of Xianxian county, Xianxian Hebei, 062250, P.R.China

Corresponding Author: BAI Yuming, Email: 315097190@qq.com

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目的 探讨关节腔注射富血小板血浆（platelet-rich plasma，PRP）治疗后，膝骨关节炎（osteoar-thritis，OA）患者血浆和关节滑液中 IL-17 水平变化。 方法 以 2015 年 1 月—2016 年 1 月接受关节腔 PRP 注射治疗（每周 1 次，连续 3 周）的 30 例膝关节 OA 患者作为研究对象（试验组），以 30 例自愿者正常膝关节作为对照（对照组）。两组研究对象性别、年龄、体质量指数比较，差异均无统计学意义（P>0.05）。试验组治疗前后采用膝关节学会评分系统（KSS）及疼痛视觉模拟评分（VAS）分别评价膝关节功能及疼痛程度。试验组患者注射 PRP 之前及第 3 次注射后 1、3、6 及 12 个月抽取肘部静脉血以及患侧关节滑液，采用 ELISA 法测量 IL-17 含量；对照组抽取肘部静脉血进行相应检测并比较。 结果 PRP 注射治疗过程中，试验组患者均未出现膝关节红肿、发热等局部感染及其他不适症状。患者均获随访，随访时间 12～15 个月，平均 13.5 个月。PRP 注射治疗后各时间点 VAS 评分均较术前显著降低，KSS 评分较术前显著增加，比较差异有统计学意义（P<0.05）；治疗后各时间点间比较，差异均无统计学意义（P>0.05）。与对照组比较，试验组 PRP 治疗前后血浆 IL-17 含量均显著增高（P<0.05）。试验组治疗后各时间点血浆及关节滑液 IL-17 含量均较治疗前显著降低（P<0.05），治疗后各时间点间比较差异均无统计学意义（P>0.05）。 结论 关节腔注射 PRP 治疗可显著改善膝关节 OA 患者疼痛症状及关节功能，并在一定程度上降低患者体内 IL-17 水平，但未恢复至正常水平。

Objective To investigate the interleukin-17 (IL-17) levels changes in both synovial fluid and venous plasma of patients with primary knee osteoarthritis (OA) after intra-articular injection of platelet-rich plasma (PRP). Methods Between January 2015 and January 2016, 30 patients with primary knee OA were treated by intra-articular injection of PRP once a week for 3 weeks (trial group). Thirty healthy individuals were recruited into the study as control. There was no significant difference in gender, age, and body mass index between 2 groups (P>0.05). Visual analogue scale (VAS) score and Knee Society Score (KSS) were used to evaluate pain level and function of the knee for patients with OA. The IL-17 levels in both venous plasma and synovial fluid were measured before injection and at 1, 3, 6, and 12 months after injection in trial group and the IL-17 levels in venous plasma were measured in control group. The levels were determined using ELISA method. Results There was no knee joint swelling, fever, local infection, and other uncomfortable symptoms for all patients in process of PRP injection. All patients were followed up 13.5 months on average (range, 12-15 months). In trial group, the VAS scores at different time points after injection were significantly lower than that before injection (P<0.05). And the KSS scores at different time points after injection were significantly higher than that before injection (P<0.05). There was no significant difference in VAS and KSS scores between different time points after injection (P>0.05). The IL-17 levels in venous plasma before and after injection in trial group were significant higher than that in control group (P<0.05). The IL-17 levels in venous plasma at each time point after injection were significant lower than that before injection (P<0.05). There was no significant difference in IL-17 levels in both venous plasma and synovial fluid between different time points after injection (P>0.05). Conclusion Intra-articular injection of PRP can significantly release the pain symptoms, improve joint function, and reduce IL-17 levels in both synovial fluid and venous plasma of the patients with knee OA, but IL-17 levels can not reduce to normal level.

关键词: 富血小板血浆; IL-17; 骨关节炎; 膝关节

Key words: Platelet-rich plasma; interleukin-17; osteoarthritis; knee

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