Lubis Andri Maruli Tua, Lubis Vita Kurniati
Department of Orthopaedics and Traumatology, Faculty of Medicine University of Indonesia, Salemba Raya 6, Jakarta 10430, Indonesia.
J Orthop Sci. 2013 Jul;18(4):519-27. doi: 10.1007/s00776-013-0387-0. Epub 2013 Apr 19.
Frozen shoulder is characterized with thickening and contracture of joint capsular. The mechanism of this disorder is not yet clear, however, some proteins have been related to frozen shoulder. This study was to compare the serum levels of proteins related to frozen shoulder, such as matrix metalloproteinase (MMP), tissue inhibitor of metalloproteinase (TIMP) and transforming growth factor-beta (TGF-β) between frozen shoulder and normal subjects; and before and after physical exercise active stretching and gentle thawing in frozen shoulder patients.
Serum levels of MMP-1, MMP-2, TIMP-1, TIMP-2, and TGF-β1 was measured from frozen shoulder and normal subjects by using ELISA. Functional assessment of shoulder joint in frozen shoulder patients was based on abbreviated Constant score. Frozen shoulder patients were randomly divided into intensive stretching and supervised neglect groups. Abbreviated Constant score and serum samples of frozen shoulder patients were evaluated at baseline, week-6, and week-12 after exercise, while only baseline serum samples of control were measured. MMP/TIMP ratio was calculated from the total sum of MMP-1 and MMP-2 levels divided by the total sum of TIMP-1 and TIMP-2 levels.
Baseline MMP-1 and MMP-2 levels were significantly lower, while TIMP-1, TIMP-2, and TGF-β1 levels were significantly higher in frozen shoulder group than in control. Increased MMPs and decreased TIMPs were significantly greater after intensive stretching than after supervised neglect exercise. Abbreviated Constant score improvement was significantly higher in intensive stretching group than in supervised neglect group.
Serum levels of MMP-1, MMP-2, TIMP-1, TIMP-2, and TGF-β1 may be associated to frozen shoulder. Active stretching can improve frozen shoulder better than supervised neglect, as demonstrated by the improvement of Constant score.
肩周炎的特征是关节囊增厚和挛缩。这种疾病的发病机制尚不清楚，然而，一些蛋白质已被发现与肩周炎有关。本研究旨在比较肩周炎患者与正常受试者之间与肩周炎相关的蛋白质血清水平，如基质金属蛋白酶（MMP）、金属蛋白酶组织抑制剂（TIMP）和转化生长因子-β（TGF-β）；并比较肩周炎患者在进行体育锻炼主动拉伸和轻柔解冻前后这些蛋白质的血清水平。
采用酶联免疫吸附测定法（ELISA）测量肩周炎患者和正常受试者血清中MMP-1、MMP-2、TIMP-1、TIMP-2和TGF-β1的水平。肩周炎患者肩关节功能评估基于简化的Constant评分。肩周炎患者被随机分为强化拉伸组和监督性忽视组。在运动后的基线、第6周和第12周评估肩周炎患者的简化Constant评分和血清样本，而对照组仅测量基线血清样本。MMP/TIMP比值通过MMP-1和MMP-2水平总和除以TIMP-1和TIMP-2水平总和来计算。
肩周炎组的基线MMP-1和MMP-2水平显著低于对照组，而TIMP-1、TIMP-2和TGF-β1水平显著高于对照组。强化拉伸后MMPs增加和TIMPs减少的幅度显著大于监督性忽视运动后。强化拉伸组的简化Constant评分改善显著高于监督性忽视组。
MMP-1、MMP-2、TIMP-1、TIMP-2和TGF-β1的血清水平可能与肩周炎有关。如Constant评分的改善所示，主动拉伸比监督性忽视能更好地改善肩周炎。
