| 李小龙,甘永杰.膝骨关节炎病人血清骨硬化蛋白、骨钙素水平变化及预后预测价值.骨科,2025,16(6): 522-526. |
| 膝骨关节炎病人血清骨硬化蛋白、骨钙素水平变化及预后预测价值 |
| Changes of serum sclerostin and osteocalcin levels and prognostic value in patients with knee osteoarthritis |
| 投稿时间：2025-03-12 |
| DOI：10.3969/j.issn.1674-8573.2025.06.008 |
| 中文关键词: 膝骨关节炎 骨硬化蛋白 骨钙素 预后 |
| 英文关键词: Knee osteoarthritis Sclerostin Osteocalcin Prognosis |
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| 中文摘要: |
| 目的 探讨膝骨关节炎（knee osteoarthritis，KOA）病人血清骨硬化蛋白、骨钙素水平变化，分析血清骨硬化蛋白、骨钙素水平预测预后的价值。方法 回顾性分析2021年10月至2024年2月我院骨科收治的95例KOA病人的资料，根据Lysholm膝关节功能评分将病人分为预后良好组（≥70分）和预后不良组（＜70分）。采用酶联免疫吸附法测定血清骨硬化蛋白、骨钙素水平；比较两组间性别、年龄、病程、身体质量指数、家族过敏史、吸烟史、饮酒史、病变部位、合并高血压、Kellgren-Lawrence（K-L）分级、血清骨硬化蛋白、骨钙素水平、白细胞介素-1、C反应蛋白、肿瘤坏死因子-ɑ、美国膝关节协会（KSS）评分和美国特种外科医院（HSS）膝关节评分的差异；采用多因素Logistic回归分析影响预后的危险因素；分析血清骨硬化蛋白、骨钙素水平预测预后的效能。结果 预后不良组K-L分级中Ⅲ级/Ⅳ级占比及骨钙素水平更高（P＜0.05）。预后不良组病人KSS评分、HSS评分、血清骨硬化蛋白表达水平更低（P＜0.05）；K-L分级、KSS评分、HSS评分、骨钙素水平均是影响KOA病人预后不良的独立危险因素，而骨硬化蛋白水平为保护因素（P＜0.05）；KSS、HSS评分与血清骨硬化蛋白水平呈正相关，与血清骨钙素水平呈负相关（P＜0.05）；血清骨硬化蛋白和骨钙素水平预测KOA病人预后不良的最佳截断点分别为86.78 pg/mL和6.94 ng/mL，二者联合的特异度和曲线下面积分别为96.36%和0.905。结论 KOA病人血清骨钙素水平异常升高，而骨硬化蛋白水平异常降低，临床检测骨硬化蛋白、骨钙素水平可作为预测KOA病人预后的敏感指标，且二者联合预测价值更高。 |
| 英文摘要: |
| Objective To investigate the changes of serum sclerostin and osteocalcin levels in patients with knee osteoarthritis (KOA), and to analyze the prognostic value of serum sclerostin and osteocalcin levels. Methods The data of 95 patients with KOA admitted to our hospital from October 2021 to February 2024 were retrospectively analyzed. They were divided into a good prognosis group (≥70 score) and a poor prognosis group (＜70 score) according to Lysholm knee function score. Serum levels of sclerostin and osteocalcin were determined by enzyme-linked immunosorbent assay. The differences in gender, age, disease duration, body mass index, family allergy history, smoking history, drinking history, lesion location, combined hypertension, Kellgren-Lawrence (K-L) grade, serum sclerosing protein, osteocalcin level, interleukin-1, C-reactive protein, tumor necrosis factor-α, and American Knee Joint Association (KSS) score and the knee joint score of Hospital for Special Surgery (HSS) in the United States were compared between the two groups. Multivariate Logistic regression analysis was used to analyze the risk factors influencing prognosis. The efficacy of serum sclerostin and osteocalcin levels in predicting the prognosis of patients with KOA was analyzed. Results The proportion of grade Ⅲ/Ⅳ in K-L grade and the level of osteocalcin in poor prognosis group were higher (P＜0.05). The KSS score, HSS score and serum sclerostin expression levels of patients with poor prognosis group were lower (P＜0.05). K-L grade, KSS score, HSS score and osteocalcin level were independent risk factors for poor prognosis in patients with KOA, while sclerostin level was protective factor (P＜0.05). KSS and HSS scores were positively correlated with serum sclerostin levels, but negatively correlated with serum osteocalcin levels (P＜0.05). The optimal cutoff points for predicting poor prognosis in patients with KOA based on serum levels of sclerostin and osteocalcin were 86.78 pg/mL and 6.94 ng/mL, respectively. The combined specificity and area under the curve of the two were 96.36% and 0.905, respectively. Conclusion The level of serum osteocalcin is abnormally increased in patients with KOA, while the level of sclerostin is abnormally decreased. Clinical detection of sclerostin and osteocalcin levels can be used as sensitive indicators to predict the prognosis of patients with KOA, and their combined prediction value is higher. |
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