The Study Of Biomarkers In Early Diagnosis Of Osteoarthritis And Its Correlation With Articular Degeneration

Part one Research on the relation between the YKL-40 levels and thesymptomatic severity of knee osteoarthritisObjective:There is closely relation between the level of YKL-40 and the OA, but no studies have been conducted to demonstrate the correlation between serum or SF concentrations of YKL-40 and symptomatic severity of OA. Given the emerging role of YKL-40 in OA, we sought to determine the association of YKL-40 levels in serum and SF with knee OA at different stages of symptomatic severity and whether YKL-40 could be used as a marker for evaluating symptomatic severity in knee OA patients.Methods: 144 patients with knee OA and 151 healthy individuals were recruited into this study. Symptomatic severity was determined using Western Ontario and McMaster Universities Arthritis Index(WOMAC) scores for OA patients. The radiographic disease severity of OA was assessed by the Kellgren-Lawrence(K-L) grading system. Serum and SF levels of YKL-40 were examined by enzyme-linked immunosorbent assay.Results: YKL-40 levels in SF were positively related to WOMAC pain, function scores and total scores. SF YKL-40 levels were significantly correlated with K-L grading in knee OA patients. YKL-40 levels in serum had no significant association with all WOMAC indexesand K-L grading in OA patients.Conclusions: YKL-40 in SF could be deemed as a potential biomarker for assessing the symptomatic severity of OA. Part two Research on the relation between the resistin levels and theseverity of knee osteoarthritis and cartilage degenerationObjective: Recent studies have shown that resistin plays an important role in the pathogenesis and progression of osteoarthritis(OA). The current study was aimed at investigating the relationship between resistin in serum and synovial fluid(SF) and disease severity in patients with knee osteoarthritis.Method: 74 patients diagnosed with knee OA and 79 healthy controls receiving regular body check in our hospital were recruited in the study. The Noyes score method was used to assess articular cartilage damage arthroscopically. The symptomatic severity was evaluated according to the Western Ontario McMaster University Osteoarthritis(WOMAC) scores. The radiographic disease severity of OA was assessed by the Kellgren-Lawrence(K-L) grading system. The resistin levels in serum and SF as well as cartilage degradation marker CTX-II in SF were determined by enzyme-linked immunosorbent assay.Results: SF levels of resistin were positively associated with the radiographic severity of knee OA, WOMAC pain, WOMAC function, and WOMAC total scores. There were no signi?cant associations of serum resistin concentrations with WOMAC subscale and K-L grading. The correlation between serum and SF resistin levels and WOMAC scores was further evaluated by multinomial logistic regression analysis. Multiple regression analysis showed that the correlation between SF resistin concentrations and WOMAC Scores was still signi?cant after removing other confounding factors.Conclusion: Resistin in SF might serves as a potential biomarker for reflecting the severity of knee osteoarthritis and cartilage degeneration. Part three A randomized controlled clinical study of limited synoviumdebridement for knee osteoarthritisObjective: The aim of this study is to compare the mid-long term effectiveness of arthroscopic limited / no synovium debridement on patients with grade Ⅱ or Ⅲ knee osteoarthritis, and to provide the best treatment options for patients with different degrees of KOA.Method: 126 patients diagnosed with knee OA were assigned into limited synovium debridement group or no synovium debridement group according to random number table method, and then performed arthroscopic limited / no synovium debridement. The clinical outcomes were assessed by visual analogue score(VAS), the MOS item short from health survey(SF-36)and WOMAC scores within 12 months follow-up postoperatively.Results: In this study, there were no statistical differences between the two groups concerning VAS scores, SF-36, WOMAC pain, WOMAC stiffness, WOMAC function, and WOMAC total scores on the 1st day postoperatively. On 1st week and 1st month postoperatively, there were no statistical differences between the two groups concerning VAS scores, SF-36, WOMAC pain and WOMAC stiffness, but there were statistical differences with regard to WOMAC function and WOMAC total scores. On 6th month postoperatively, the two groups had statistical differences in terms of VAS scores, SF-36, WOMAC pain, WOMAC stiffness, WOMAC function and WOMAC total scores. On 12 th month postoperatively, there were statistical differences between the two group concerning SF-36, WOMAC stiffness, WOMAC function and WOMAC total scores without complications of infection and neurovascular injury found. At each follow-up time point, there were statistical differences between the two groups concerning VAS pain scores, SF-36, WOMAC pain, WOMAC stiffness, WOMAC function and WOMAC total scores before and after surgery, which suggested that treatment of knee osteoarthritis with arthroscopic techniques could alleviate knee pain,improve knee function and stiffness, and improve the quality of life of patients with KOA. In long term follow-up, SF-36, WOMAC function and WOMAC total scores of limited synovium debridement group were superior to those of no synovium debridement group.Conclusion: Treatment for patients with grade Ⅱ or Ⅲ knee osteoarthritis using arthroscopic limited synovium debridement could clear up affected synovium, ease knee pain, improve knee function, improve the quality of life of elderly patients, and achieve significant mid-long term effectiveness.