Page 72 - 中国全科医学2022-29

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postmenopausal women，but there is a lack of clinical evidence on whether it has an association with decreased sex hormone
levels and inflammatory cytokines in the synovial fluid. Objective To assess the associations of degenerative KOA pain with sex
hormones in the serum 〔estradiol（E 2 ），testosterone（T），prolactin，luteinizing hormone（LH），follicle-stimulating
hormone（FSH） and progesterone（P）〕，and inflammatory cytokines in synovial fluids 〔interleukin-1（IL-1），IL-6，
IL-10 and tumor necrosis factor-α（TNF-α）〕 in postmenopausal women，providing a novel basis for estrogen hormone
treatment of pain induced by degenerative KOA. Methods Ninety postmenopausal women with pain induced by degenerative
KOA were recruited from the Sixth Affiliated Hospital of Xinjiang Medical University from June 2019 to June 2021，including 30
with mild pain（VAS score ≤ 3），30 with moderate pain（VAS score higher than 4 but lower than 7），and 30 with severe
pain（VAS score higher than 7 but lower than 10）. They were compared to 30 postmenopausal women with knee effusion（controls）
undergoing physical examination in the hospital during the same period. The levels of serum sex hormones and inflammatory
cytokines in synovial fluids were measured in all cases. All subjects were tested for sex hormones in the serum and inflammatory
cytokines in synovial fluids. Results The BMI differed across mild，moderate，and severe pain subgroups and the controls
（P<0.05）. In particular，severe pain subgroup had higher BMI than did controls and mild pain subgroup（P<0.05）. The
serum levels of E 2 and T differed across mild，moderate，and severe pain subgroups and the controls （P<0.05）. Specifically，
the controls had higher levels of E 2 and T than did moderate and severe pain subgroups（P<0.05）. The E 2 level in the moderate
pain subgroup was lower than that of mild pain subgroup（P<0.05）. The E 2 and T levels in the severe pain subgroup were lower
than those in the mild pain subgroup（P<0.05）. There were no significant differences in prolactin，LH，FSH and P between
controls，and mild，moderate and severe pain subgroups（P>0.05）. The levels of IL-1，IL-6，and IL-10 as well as TNF-α
varied across mild，moderate，and severe pain subgroups and the controls（P<0.05）. Compared with controls，mild pain
subgroup had higher IL-1 level，and moderate and severe pain subgroups had higher IL-1，IL-6，IL-10 and TNF-α levels
（P<0.05）. The levels of IL-6，IL-10 and TNF-α in severe pain subgroup were higher than those in mild pain subgroup（P<0.05）.
E 2 and T levels were negatively correlated with VAS score for degenerative knee pain（r s =-0.686，-0.454，P<0.05）；IL-1，
IL-6 and TNF-α levels were positively correlated with VAS score for degenerative knee pain（r s =0.517，0.665，0.319，
P<0.05）. There was no correlation between IL-10 and VAS score for degenerative knee pain （r s =0.162，P>0.05）. Conclusion
In postmenopausal women，VAS score for degenerative knee pain was negatively correlated with E 2 and T levels. There was
no significant difference in prolactin，LH，FSH and P levels among degenerative KOA patients with different pain levels. The
IL-1，IL-6 and TNF-α levels in synovial fluids were positively correlated with the VAS score of degenerative knee pain. So
reducing the levels of IL-1，IL-6 and TNF-α could improve the tolerance of knee pain，which may be a reference for clinical
treatment of degenerative knee pain.
【Key words】 Sex hormones；Synovia；Postmenopause；Inflammatory factors；Knee pain；Osteoarthritis，knee

性激素在人体内参与各种生理机制的调节，不同的 供理论依据，进一步预防和治疗退变性 KOA 疼痛。
性激素具有不同的生物学活性；更年期女性体内性激素 1 资料与方法
水平存在明显波动，绝经后呈现明显下降趋势，体内各 1.1 一般资料 试验者：选取新疆医科大学第六附属
种细胞代谢出现调节失衡，对不同的组织和器官直接或 医院2019年6月至2021年6月，因退变性KOA疼痛
间接地产生了较大的影响。有研究表明不同组织部位的 住院的女性绝经患者 90 例。纳入标准：（1）45~65 岁
雌激素具有不同的抗炎和促炎特性，一般来说短时间内 已绝经的退变性 KOA 疼痛女性；（2）患者同意签署有
雌激素的降低会增加体内活性氧水平，激活核因子 κB 创穿刺知情同意书且愿意测定性激素六项；（3）膝关
和促炎性细胞因子的产生 ［1］ 。绝经后随着雌激素水平 节存在一定量的积液且膝关节核磁或 B 超显示能够抽取
的降低，退变性膝骨关节炎（KOA）发生关节疼痛也明 积液。排除标准：（1）有其他内分泌系统及风湿免疫
显增多，有研究报道雌激素水平降低后机体对疼痛的抑 系统等相关疾病；（2）近期有膝关节创伤史或手术史；
制作用减弱，炎性因子也会进一步升高 ［2］ 。这表明雌 （3）既往有膝关节穿刺治疗史；（4）全身或局部存在
激素、炎性因子及疼痛存在一定的联系；绝经后退变性 感染。
KOA 膝关节疼痛是否也与性激素和炎性因子有关？目 住院后充分告知患者视觉模拟量表（VAS）评分的
前尚缺乏此方面的临床实际研究证据。本研究旨在探讨 意义 ［3］ ，患者自行评分后再由 3 位中级以上职称医师
绝经后退变性 KOA 疼痛与性激素水平及炎性因子是否 核实查体评估，根据评分结果取平均值并进行分组。轻
相关，为临床女性绝经后性激素替代疗法及抗炎治疗提 度疼痛组 30 例（VAS 评分≤ 3 分），年龄 45~65 岁、