Correlation Study Of TCM Syndrome Types Of Knee Osteoarthritis With X-ray,Ultrasound Imaging And Serum COL-Ⅱ,CTX-Ⅱ,COL10A1 Levels

ObjectiveObserve the specific changes of X-ray and ultrasound imaging of patients with knee osteoarthritis(Knee osteoarthritis,KOA)and the expression levels of COL-Ⅱ,CTX-Ⅱ and COL10A1 in the peripheral blood.Relevance provides an objective basis for the KOA syndrome differentiation study.MethodsAccording to the inclusion criteria,96 KOA patients in the Orthopedics Outpatient Department of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine were selected.After collecting the data from the four clinics,the syndrome differentiation was performed according to the TCM syndrome standard,and the knee X-rays and ultrasound examinations were performed after reading the relevant records.Change,use ELISA method to detect the serum COL-Ⅱ,CTX-Ⅱ and COL10A1 expression levels of subjects,and analyze their correlation after statistical analysis.ResultsA total of 96 KOA cases were selected after the screening of various criteria in this study.The frequency of TCM syndromes is ranked from high to low.The first is liver and kidney deficiency type(42.71%);the second is blood stasis obstructive type(25%);The third is the wind-cold-dampness arthralgia(18.75%);the fourth is the rheumatic arthralgia(13.54%);comparing the different syndrome types and the course of the disease,it is found that the liver and kidney deficiency type has the longest course of disease and is statistically significant compared to other syndromes(P<0.01);and the comparison with age,sex,and onset joints was not statistically significant.There are significant differences in the X-ray KL grading of each syndrome type.Grade I stroke with rheumatic arthralgia type accounted for the highest proportion(46.2%),Grade II stroke with wind-cold-dampness arthralgia type accounted for the highest proportion(44.4%),and Grade III liver and kidney deficiency type The highest proportion(48.8%),followed by blood stasis obstructive type(41.7%),the above differences were statistically significant(P<0.05).In the comparison of TCM syndrome types and X-ray specific changes,in the patellofemoral joint osteophyte grade 0(normal),the two types with the highest proportion are Fenghanshibi(55.6%)and Fengshi-heatbi(53.8%).In the first grade(bone spine tip),the two types with the highest proportion are blood stasis obstruction(62.5%)and liver and kidney deficiency(46.3%),the difference is statistically significant compared with the other two types(P<0.05));In the grade 0(normal)of tibial intercondylar osteophytes,the two types with the highest proportion are Fenghan Shibi(55.6%)and Fengshi-heat Bi(53.8%),with the highest proportion in Grade 2(obvious)The two types of KOA are blood stasis obstruction(37.5%)and liver and kidney deficiency(34.1%).The difference is statistically significant compared with the other two types(P<0.05);the highest proportion of subchondral sclerosis in KOA patients is liver Kidney deficiency type(68.3%),followed by wind-cold-dampness type(55.6%)(P<0.05);KOA knee subluxation of liver-kidney deficiency type accounted for the highest and lowest rate compared with wind-cold-dampness type and rheumatic-heat type It is of wind-cold-dampness arthralgia type(P<0.05);different syndromes are related to the stenosis of the medial and lateral tibiofemoral and patella joints,the osteophytes of the medial and lateral tibiofemoral joints,the Wiberg classification of the patella,the tibial angle,the tibiofemoral angle,and the subchondral bone There was no statistical difference in cystic changes,local osteoporosis,and intra-articular loose bodies(P>0.05);Analyzing the correlation between syndrome types and ultrasound,the anterior and posterior diameters of the suprapatellar sac fluid of different TCM syndrome types are arranged in descending order as blood stasis obstruction,rheumatic-heat arthralgia,liver and kidney deficiency,wind-cold-dampness arthralgia,and there are significant differences(P<0.01);The thickness of synovial membrane of different TCM syndromes is arranged in descending order as blood stasis obstruction,liver and kidney deficiency,rheumatism-heat arthralgia,wind-cold dampness arthralgia,and there are significant differences(P < 0.01);from three parts of cartilage In terms of thickness,the thickness of cartilage in three parts of patients with liver and kidney deficiency type KOA was thinner than the other three types,and the difference was significant(P<0.001).At the level of COL-Ⅱ,the liver and kidney deficiency type was higher than the wind-cold-dampness arthralgia and rheumatic arthralgia type(P<0.05);at the CTX-II level,the wind-cold-dampness arthralgia type was lower than the other three types(P<0.001);The level of COL10A1 was highest in blood stasis and obstructive type,and lowest in wind-cold-dampness type(P<0.001).The level of COL-Ⅱ in the K-L classification is ranked from small to large as Ⅰ < Ⅱ < Ⅳ < Ⅲ,and the horizontal arrangement of CTX-Ⅱ and COL10A1 is Ⅰ<Ⅳ<Ⅱ<Ⅲ(P<0.001).Conclusion1.There is a correlation between KOA TCM syndrome types and X-ray grades and their specific changes.Among them,rheumatic arthralgia and wind-cold dampness arthralgia are more common in grades Ⅰ and Ⅱ,and liver and kidney deficiency and blood stasis obstructive types are more common in Ⅲ,Grade IV;blood stasis obstruction type and liver and kidney deficiency type KOA are more prone to tibial intercondylar osteophytes and patellofemoral joint osteophytes;liver and kidney deficiency type KOA is the most prone to subchondral bone sclerosis,followed by wind-cold-dampness type KOA;Knee subluxation is most likely to occur in KOA of liver and kidney deficiency.2.Ultrasound examination provides a certain basis for KOA syndrome differentiation.Increased suprapatellar sac effusion is common in KOA of blood stasis obstruction and rheumatism-heat arthralgia type,but rare in wind-cold-dampness arthralgia type;synovial thickening is more common in blood stasis obstruction Obstruction type and liver and kidney deficiency type KOA;while liver and kidney deficiency type KOA is more prone to cartilage thickness thinning.3.Serum COL-Ⅱ,CTX-Ⅱ and COL10A1 levels can provide an objective basis for KOA syndrome differentiation.COL-Ⅱ can be used as a reference indicator for KOA with liver and kidney deficiency;CTX-Ⅱ can be used as a reference for KOA with wind,cold and dampness.Index:COL10A1 can be used as a reference index for blood stasis obstructive KOA.4.Serum COL-Ⅱ,CTX-Ⅱ and COL10A1 levels combined with K-L grading can effectively reflect the severity of KOA,that is,the K-L grades I to IV show a first upward trend,and the concentration reaches a peak at Ⅲ level and then begins to decrease.