探讨膝骨关节炎关节镜下病变特征与血清微小RNA-27a(miRNA-27a)、Toll样受体4(TLR4)水平的相关性。

选取2019年4月至2020年10月在恩施土家族苗族自治州中心医院诊断为膝骨关节炎并接受关节镜下手术治疗的170例膝骨关节炎患者，作为膝骨关节炎组，同时间170例健康体检者作为对照组；排除临床资料不全的。采用实时荧光定量PCR及酶联免疫吸附法检测血清miRNA-27a、TLR4水平，观察关节镜下患者病变特征，主要为软骨损伤程度、半月板损伤程度、滑膜改变、游离体及骨质增生形成，单因素方差分析不同病变特征膝骨关节炎患者血清miRNA-27a、TLR4水平差异。采用Pearson检验分析膝骨关节炎患者血清miRNA-27a与TLR4水平的关系。

膝骨关节炎组患者血清miRNA-27a水平明显低于对照组(t＝53.706，P<0.05)，血清TLR4水平明显高于对照组(t＝47.037，P<0.05)，且两者呈负相关(r＝-0.462，P<0.05)。不同软骨损伤程度和半月板损伤程度患者血清miRNA-27a水平从高到低为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级，血清TLR4水平从高到低为Ⅳ级、Ⅲ级、Ⅱ级、Ⅰ级，总体比较差异有统计学意义(F＝88.792、76.093、81.652，均为P<0.05)；不同滑膜改变分级患者血清miRNA-27a水平从高到低为Ⅰ、Ⅱ、Ⅲ级，血清TLR4水平从高到低为Ⅲ、Ⅱ、Ⅰ级，总体比较差异有统计学意义(F＝25.581、24.999、12.426，均为P<0.05)；各级别间两两比较差异均有统计学意义(均为P<0.05)。游离体和骨质增生Ⅰ级患者血清miRNA-27a水平均明显低于0级患者(t＝7.280、6.756，均为P<0.05)，血清TLR4水平均明显高于0级患者(t＝5.511、5.128，均为P<0.05)。

膝骨关节炎患者血清miRNA-27a水平降低、血清TLR4水平升高，两者水平变化与患者关节镜下病变特征有关。

To investigate the correlation between the pathological characteristics of knee osteoarthritis under arthroscope and the levels of serum microRNA-27a (miRNA-27a) and toll-like receptor 4 (TLR4).

From April 2019 to October 2020, 170 patients with knee osteoarthritis who underwent arthroscopic surgery in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture and treated under arthroscope were selected as the knee osteoarthritis group, and 170 healthy people at the same time were selected as the control group. Those with incomplete clinical data were excluded. The serum levels of miRNA-27a and TLR4 were detected by real-time fluorescence quantitative PCR and enzyme linked immunosorbent assay, the pathological characteristics of the patients were observed under arthroscopy, including the degree of cartilage injury, meniscus injury, synovial changes, free body and bone hyperplasia, the differences of serum levels of miRNA-27a and TLR4 in the patients with knee osteoarthritis with different pathological features were analyzed by one way ANOVA. The relationship between serum miRNA-27a and TLR4 levels in the patients with knee osteoarthritis was analyzed by Pearson test.

The level of serum miRNA-27a in the knee osteoarthritis group was significantly lower than that in the control group (t=53.706, P <0.05), and the level of serum TLR4 was significantly higher than that in the control group (t=47.037, P<0.05), and there was a negative correlation between them (r=-0.462, P<0.05). The levels of serum miRNA-27a in patients with different degrees of cartilage injury and meniscus injury were grade I, II, III and IV from high to low, and the levels of serum TLR4 were grade IV, III, II and I from high to low; the total differences among the groups were statistically significant(F=88.792, 76.093, 81.652, all P<0.05); the levels of serum miRNA-27a in patients with different synovial change grades were grade I, II and III from high to low, and the levels of serum TLR4 were grade III, II and I from high to low, total differences among the groups were statistically significant (F=25.581, 24.999, 12.426, all P<0.05). There were statistically significant differences between the different grades (all P<0.05). The level of serum miRNA-27a in the patients with loose body and hyperosteogeny grade I was significantly lower than the patients with grade zero (t=7.280, 6.756, both P <0.05), and the level of serum TLR4 in the patients with loose body and hyperosteogeny grade I was significantly higher than the patients with grade zero (t=5.511, 5.128, both P<0.05).

The level of serum miRNA-27a is decreased and the level of serum TLR4 is increased in patients with knee osteoarthritis. The changes of both levels are related to the characteristics of arthroscopic lesions.