| Background:Osteoarthritis is a rapidly growing disabling total joint disease worldwide,often resulting in chronic pain and reduced quality of life in older adults.Knee Osteoarthritis(KOA)is the most common type of osteoarthritis,and there is no clear cure at present.In clinical practice,oral non-steroidal anti-inflammatory drugs,physical therapy,exercise therapy and surgical treatment are mainly used.Platelet-Rich Plasma(PRP)contains more than physiological concentration of platelets and a variety of bioactive proteins,which is helpful for tissue repair and inflammation regulation.It can directly act on the injured site by ultrasoundguided intra-articular injection.The in-depth study of biomarkers can provide us with opportunities for better diagnosis and disease stratification.Inflammatory cytokines are common biomarkers of knee osteoarthritis.The aim of this study is to observe the changes of inflammatory cytokines in knee synovial fluid before and after platelet-rich plasma(PRP)treatment,and to explore the biological effect and possible mechanism of PRP injection in the treatment of knee osteoarthritis.Objective:To observe the changes of inflammatory cytokines in the synovial fluid of knee joint in patients with KOA treated by PRP,and to explore the effect of PRP injection on the inflammatory state of knee joint environment and the possible mechanism of action.Methods:Seventy patients with knee osteoarthritis who met the exclusion criteria were divided into observation group(35 cases)and control group(35 cases)according to random number table method.All patients in 2groups were given health education and quadriceps training.The observation group was given intraarticular injection of PRP,3.5ml each injection,once a week for 3 weeks.The control group was given intraarticular injection of sodium hyaluronate injection,2ml each time,and sodium hyaluronate was given once a week for3 weeks.A total of 67 patients completed the study.The concentrations of inflammatory cytokines IL-6,IL-1β,TNF-α,IL-8,IL-17 A,IL-17 F,IL-4,IL-5,and IL-10 in synovial fluid of knee joint were measured before and after the first injection and one week after the third injection to evaluate the changes of inflammatory cytokines before and after the intervention.The Western Ontario and McMaster University Osteoarthritis Index Scale was used before,after,1 month after,3 months after,and 6 months after the intervention(Western Ontario and McMaster University,WOMAC,American knee society knee score(AKS)and visual analogue scale(VAS)were used to evaluate the knee function and pain of patients in the 2 groups,and to evaluate the clinical treatment effect.Results:Changes of cytokine concentrations in knee synovial fluid of patients in the two groups before and after intervention: there were no statistically significant differences in the concentrations of cytokines IL-6,IL-1β,TNF-α,IL-8,IL-17 A,IL-17 F,IL-4,IL-5 and IL-10 in knee synovial fluid of patients in the two groups before intervention(P>0.05).After intervention,the concentrations of IL-6,IL-1β,TNF-α,IL-17 A and IL-10 in the observation group were lower than those before treatment,and the differences were statistically significant(P<0.001),the concentrations of IL-8,IL-17 F and IL-4 were lower than those before treatment,and the differences were not statistically significant(P>0.05),and the concentration of IL-5 was higher than that before treatment.The difference was not statistically significant(P>0.05).After intervention,the concentrations of IL-6,IL-8,IL-17 F,TNF-α,IL-1β,IL-17 A,IL-10 and IL-4 in the control group were lower than those before treatment,and the difference was not statistically significant(P>0.05);the concentration of IL-5 was higher than that before treatment,and the difference was not statistically significant(P>0.05).Between-group comparisons found that: After intervention,the concentrations of cytokines IL-6,IL-1β,TNF-α,IL-17 A and IL-10 in the knee joint synovial fluid of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The concentrations of IL-8,IL-17 F and IL-4 in the knee joint synovial fluid of the observation group were lower than those of the control group,and the differences were not statistically significant(P>0.05).The concentration of IL-5 was lower than that of the control group,but the difference was not statistically significant(P>0.05).Before intervention,the WOMAC score,AKS score and VAS score of the observation group and the control group were(145.15±27.08)and(144.45±30.82),AKS score were:(83.09±17.91),(83.45±26.83),VAS scores were(6.41±1.26),(6.39±1.41),respectively,and the differences were not statistically significant.After intervention and during follow-up,the efficacy scores of the two groups were [WOMAC scores of the observation group and the control group after intervention were(97.21±32.67)and(102.45±22.03),AKS scores were(112.12±21.54)and(108.94±22.07),VAS scores were: At 1 month after intervention,the WOMAC scores of the observation group and the control group were(69.44±22.69)and(97.18±27.19),and AKS scores were:(130.12±20.11),(115.36±25.83),VAS scores were(2.79±1.2),(3.82±1.51);WOMAC scores of the observation group and the control group were:(64.03±24.43)and(107.39±29.48),AKS scores were(138.85±22.25)and(107.69±24.42),VAS scores were: The WOMAC scores of the observation group and the control group were(66.91±26.35)and(121.27±33.03),and AKS scores were:(2.38±1.18)and(4.12±1.69).(136.94±23.14),(96.42±24.04),VAS scores were(2.47±1.13),(4.51±1.72),respectively,which were better than the scores before intervention in the group,with statistically significant differences(P<0.001).The comparison between the two groups found that the WOMAC and VAS scores of the observation group were lower than those of the control group,and the AKS score was higher than that of the control group after the intervention,1 month,3 months and 6 months after the intervention,and there was no statistically significant difference after the intervention(P<0.05),but there were statistically significant differences in 1 month,3 months and 6 months after the intervention(P<0.05).Conclusion:Platelet-rich plasma therapy can reduce the concentrations of inflammatory factors IL-6,IL-1β,TNF-α,IL-17 A and IL-10 in the synovium of KOA patients,reduce the expression levels of IL-8,IL-17 F and IL-4,clear pro-inflammatory factors,improve the inflammatory environment of the affected knee joint,and alleviate the pain caused by inflammatory factors.It can reduce pain and improve knee function in patients with KOA and is an effective choice for the treatment of knee osteoarthritis. |
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