血清IL-17和MMP-13对骨性膝关节炎患者关节镜下膝关节外侧支持带松解术后预后不良的预测价值

Predictive value of serum IL-17 and MMP-13 for poor prognosis in patients with knee osteoarthritis undergoing arthroscopic knee lateral retinacular release surgery

摘要:

目的 探究血清白细胞介素-17（IL-17）和基质金属蛋白酶-13（MMP-13）对骨性膝关节炎（KOA）患者关节镜下膝关节外侧支持带松解术后预后不良的预测价值。方法 选取2022年1月－2024年1月在佳木斯大学宏大医院就诊的KOA患者145例，采用酶联免疫吸附试验（ELISA）检测血清IL-17和MMP-13水平，术后随访1年，Lysholm评分为70～100分的为预后良好组（108例）， < 70分的为预后不良组（37例）；针对关节镜下膝关节外侧支持带松解术后预后不良的KOA患者，采用Pearson法，分析血清IL-17与MMP-13的相关性；采用多因素Logistic回归模型，分析影响预后不良的独立危险因素；绘制受试者操作特征曲线（ROC curve），分析血清IL-17和MMP-13预测术后预后不良的效能。结果 预后不良组年龄大于预后良好组，受累间室个数 ≥ 2占比高于预后良好组，差异均有统计学意义（P < 0.05）；预后不良组血清IL-17和MMP-13水平高于预后良好组，差异均有统计学意义（P < 0.05）；预后不良组血清IL-17和MMP-13水平呈正相关（r = 0.464，P = 0.000）；年龄 ≥ 60周岁、受累间室个数 ≥ 2、血清IL-17和血清MMP-13水平高，是影响KOA患者关节镜下膝关节外侧支持带松解术后预后不良的独立危险因素（P < 0.05）；血清IL-17、MMP-13水平和联合检测，预测KOA患者关节镜下膝关节外侧支持带松解术后预后不良的曲线下面积（AUC）分别为：0.830、0.815和0.916，联合预测效果更优（Z_{IL-17与联合检测比较} = 2.783、Z_{MMP-13与联合检测比较} = 3.289，P_{IL-17与联合检测比较} = 0.005、P_{MMP-13与联合检测比较} = 0.001）。结论 关节镜下膝关节外侧支持带松解术治疗后，预后不良的KOA患者在术后14 d时，血清IL-17和MMP-13水平较预后良好患者高，两者联合检测具有较高的预测价值；年龄 ≥ 60周岁、受累间室个数 ≥ 2、血清IL-17和血清MMP-13水平高是影响预后不良的独立危险因素，应加强防范。

Abstract:

Objective To explore the predictive value of serum interleukin-17 (IL-17) and matrix metalloproteinase-13 (MMP-13) for poor prognosis after arthroscopic knee lateral retinacular release gurgery in patients with knee osteoarthritis (KOA).Methods A total of 145 KOA patients who were treated at the Hongda Hospital of Jiamusi University from January 2022 to January 2024 were selected. Serum IL-17 and MMP-13 levels were measured using the ELISA method. Patients were followed up for 1 year postoperatively. Those with a Lysholm score of 70 ~ 100 were classified as the good prognosis group (108 cases), while those with a score < 70 were classified as the poor prognosis group (37 cases). For KOA patients with poor prognosis after arthroscopic lateral retinacular release of the knee, the Pearson method was used to analyze the correlation between serum IL-17 and MMP-13. A multivariate logistic regression model was used to analyze independent risk factors affecting poor prognosis. Receiver operating characteristic curve (ROC curve) were plotted to evaluate the efficacy of serum IL-17 and MMP-13 in predicting postoperative poor prognosis.Results The poor prognosis group was older than the good prognosis group, and the proportion of patients with ≥ 2 affected compartments was higher than that of the good prognosis group, with all differences being statistically significant (P < 0.05); the serum levels of IL-17 and MMP-13 in the poor prognosis group were higher than those in the good prognosis group, with all differences being statistically significant (P < 0.05); serum IL-17 and MMP-13 levels were positively correlated in the poor prognosis group (r = 0.464, P = 0.000); age ≥ 60 years, ≥ 2 affected compartments, high serum IL-17, and high serum MMP-13 levels were independent risk factors affecting poor prognosis after arthroscopic knee lateral retinacular release in KOA patients (P < 0.05); the area under the curve (AUC) for predicting poor prognosis after arthroscopic knee lateral retinacular release in KOA patients were 0.830, 0.815, and 0.916 for serum IL-17, MMP-13, and combined testing, respectively, with combined prediction being superior (Z _{for IL-17 vs. combined} = 2.783, Z _{for MMP-13 vs. combined} = 3.289, P _{for IL-17 vs. combined} = 0.005, P _{for MMP-13 vs. combined} = 0.001).Conclusion After arthroscopic lateral retinacular release of the knee joint, KOA patients with poor prognosis has higher serum IL-17 and MMP-13 levels at 14 days postoperatively compared to patients with good prognosis. The combined detection of both has a high predictive value; age ≥ 60 years, the number of affected compartments ≥ 2, and high serum IL-17 and MMP-13 levels are independent risk factors affecting poor prognosis and should be closely monitored.