中文摘要：

目的 分析成人大骨节病患者血清透明质酸、肿瘤坏死因子α、血管内皮生长因子、NO和硒的含量,探讨其与临床表现的关系.方法 选择陕西省大骨节病区永寿县、非大骨节病区西安市长安区216例调查对象,依据中国大骨节病诊断标准[GB16003-1995]和病例排除与纳入标准随机分为成人大骨节病组25例,病区健康对照组20例,非病区健康对照组20例,平均年龄、性别无差别.采用ELISA、硝酸还原酶法和石墨炉原子吸收法测定血清中TNF-α、血管内皮生长因子、透明质酸、一氧化氮和硒的含量.结果 （1）大骨节病组血清一氧化氮含量（41.7±21.89）μmol/l显著高于病区内（17.1±13.01）μmol/l、外对照组（17.58±11.48）μmol/l（F=13.11,df=2,P＜0.001）;（2）大骨节病组血清TNF-α含量（32.7±3.55）pg/ml显著高于病区外对照组（30.95±2.22）pg/ml（F=3.672,df=2,P=0.031）,但与病区内对照组（32.7±3.55）pg/ml之间无统计学差异;（3）判别分析筛选出成人大骨节病患者与病区、非病区对照有差异的血清学指标为TNF-α和一氧化氮.结论 成人大骨节病血清TNF-α和一氧化氮显著增高,且与临床表现变化有关.

英文摘要：

Objective To investigate the association of serum levels of hyaluronic acid （HA）, tumor necrosis factor-α （TNF-α）, vascular endothelial growth factor （VEGF）, NO, and Se with the clinical manifestations in adult patients with Kashin-Beck disease （KBD）. Methods Totall 216 adults were selected for KBD screening from the KBD-prevalent areas in Yongshou county and the non-KBD areas of Chang＇an county, Xi＇an city, ShaanXi Province. According to the National Diagnostic Criteria of Kashin-Beck Disease in China, the diagnoses of KBD was established in 25 adult patients （11 men and 14 women, average age of 47.88±11.16 years）, and 20 healthy control subjects from the KBD areas （8 men and 12 women, average age of 47.85±12.05 years） and 20 from the non-KBD areas （8 men and 12 women, average age of 47.45±11.24 years） were also selected to serve as controls. There was no significant difference in the average age and gender distribution between the 3 groups. The serum levels of HA, TNF-α, VEGF, NO and Se were measured by enzyme-linked immunosorbent assay, nitrate reductase method and griphite furnace atomic absorption spectrometry. Results Serum NO .level was significantly higher in KBD group （41.7±21.89 μmol/L） than in the health controls from KBD areas （17.1±13.01 μmol/L） and non-KBD areas （17.58±11.48 μmol/1, F=13.11, df=2, P〈0.001）. Serum TNF-α level in KBD group （32.7±3.55 pg/ml） was significantly higher than that in the control subjects from the non-KBD areas （30.95±2.22 pg/ml, F=3.672, df=2, P=0.031）, but similar with the control subjects from the KBD areas （32.7±3.55 pg/ml）. Serum TNF-α and NO levels were identified as the indices that differed between adult KBD patients and the controls from both KBD and non-KBD areas by differential analysis （the function of differentiation was 0.062×NO＋0. 173×TNF -7.218）. Conclusion Serum TNF-α and NO levels are significantly increased in adult KBD patients and are associated with the clinical manifest