Study On The Correlation Between The Content Of HIF-1α And TNF-α And Pain Score And Bone Marrow Edema Of Bone Contusion Around The Ankle Joint

Objective:To analyze the correlation between HIF-1α,TNF-α,pain score and bone marrow edema of bone contusion around ankle joint,and to explore the role and possible mechanism of HIF-1α signaling pathway in the formation of bone marrow edema and pain in bone contusion around the ankle joint,and to provide basis for clinical treatment of bone contusion around the ankle joint.Methods:1.From May 2019 to November 2020,30 patients with bone contusion around ankle joint were included in the bone marrow edema group,while 30 patients without bone marrow edema detected by MRI of soft tissue contusion of the ankle joint were included in the non bone marrow edema group.There were collected such as gender,age,site and time of injury,the cause of injury.2.The affected ankle joint was examined by MRI,and the Region of interest area(ROIA)of bone contusion and bone marrow edema around the ankle joint was measured by two persons;The degree of ankle pain was assessed by numerical rating scale(NRS)on admission.3.Venous blood was collected on admission,centrifuged and stored at-80℃.Serum inflammatory factor HIF-1α and TNF-α Content were detected by ELISA.4.Chi square test of gender,age,site and time of injury,cause of injury and other general information,independent sample t test of pain score by NRS and the content of serum inflammatory factor HIF-1α,TNF-α,according to α=0.05,the difference was statistically significant(P<0.05).5.Pain score by NRS,region of interest area of bone marrow edema,the content of serum inflammatory factor HIF-1α,TNF-αwere determined by linear correlation analysis.Two groups of patients were divided into mild pain groups and severe pain groups through pain score by NRS,compared with the ROIA of bone marrow edema and serum inflammatory factor HIF-1α and TNF-α,using non-parameter rank and test,when p<0.05,there was statistical significance.6.Univariate linear regression was analyzed between the degree of pain score by NRS and serum inflammatory factor HIF-1α,TNF-α,the ROIA of bone marrow edema,while was analyzed between ROIA of bone marrow edema and the content of inflammatory cytokines HIF-1α and TNF-α,when p<0.05,there was statistical significance.7.Pain score by NRS was used as the dependent variable Y,serum inflammatory factor HIF-1α was taken as the independent variable X1 and TNF-α was taken as the independent variable X2.Multiple linear regression was used to analyze the factors affecting the occurrence of the pain of bone contusion around ankle joint.Results:1.There were no differences between the two groups in gender,age,injury site and time,injury cause,pain score by NRS and other factors(p>0.05),but there were statistical differences in the content of inflammatory cytokines HIF-1α and TNF-α between the two groups(P<0.05).2.The results of linear correlation analysis showed that there was a linear correlation between the levels of inflammatory cytokines HIF-1α and TNF-α in the ankle bone contusion group(P<0.05);there was a linear correlation between pain score by NRS and the content of HIF-1α and TNF-α(P<0.05),there was no linear correlation between pain score by NRS and ROIA of bone marrow edema(P>0.05);There was no linear correlation between ROIA of bone marrow edema and HIF-1α and TNF-α in bone marrow edema group(P>0.05).The mild pain group was compared to the patients with severe pain,there was no statistically significance between the ROIA and content of serum HIF-1α.The content of TNF-α in the medium and severe pain group was higher than the mild pain group(P<0.05).3.Single factor linear regression analysis showed that there was a linear regression relationship between pain score by NRS and serum levels of inflammatory cytokines HIF-1α and TNF-α in bone contusion around the ankle(P<0.05),there was no linear regression relationship between ROIA of bone marrow edema and pain score by NRS,inflammatory cytokines HIF-1α and TNF-α(P>0.05).The pain score by NRS of bone contusion around the ankle joint in the bone marrow edema group was used as the dependent variable Y,the content of serum HIF-1α(ng/ml)was taken as the independent variable X1.The content of serum TNF-α(pg/ml)was taken as the independent variable X2.Multiple linear regression analysis was conducted.Multiple linear regression results showed that multiple linear regression equation was Y =-2.362+ 6.151 X1+ 0.089 X2,and the contents of inflammatory factors HIF-1α and TNF-α were the main factors affecting the pain score by NRS in patients with bone contusion around the ankle joint(P<0.05).Conclusion: Pain scores by NRS in patients with bone bruise around the ankle joint do not reflect the degree of bone marrow edema.The degree of bone marrow edema in patients with bone contusion around the ankle joint does not indicate the pain situation.Bone marrow edema after bone contusion around the ankle joint may promote the release of HIF-1α and TNF-α of the HIF-1α signaling pathway molecules,and TNF-α/ HIF-1α Signal pathway may be involved in the pain of bone contusion around ankle joint.