Factors associated with pain and functional limitation in Japanese male patients with knee osteoarthritis

The present study investigated factors associated with knee pain and functional limitation in knee OA patients. Subjects were 109 Japanese males who were newly diagnosed with knee OA at three university hospitals over a 1-year period. Knee pain and functional limitation in walking and climbing and/or descending stairs were selected as outcome measures. To assess factors associated with outcomes, we calculated odds ratios (OR) using logistic regression analysis. Taller height (≥163 vs. <163 cm) showed a negative association with knee pain, “Pain on walking”: OR = 0.08, 95% confidence interval = 0.01–0.79; “Pain on stairs”: 0.25, 0.08–0.82. A significant characteristic related to a lesser degree of functional disability was alcohol consumption (“Waking distance”: 0.34, 0.14–0.84; “Help on stairs”: 0.21, 0.09–0.51). In the present study, knee pain was associated with shorter height in male Japanese patients with knee OA. Functional limitation was associated with no consumption of alcohol.     

Correlation between serum leptin,cytokines, cartilage degradation and functional impact in obese knee osteoarthritis patients

Aim of the workThe aim of the present work was to correlate between serum level of leptin, matrix metalloproteinase-13 (MMP13), interleukin-1β (IL1β), tumour necrosis factor (TNF-α), nitric oxide (NO) and functional impact in obese patients with knee osteoarthritis (KOA).Patients and methodsThe study included 84 obese patients suffering from primary KOA. The knees were examined; pain assessed by visual analogue scale (VAS) and Lequesne’s index for functional impact calculated. Serum leptin, MMP13, IL1β, TNF-α and NO were assessed.ResultsThe mean age of the patients was 54.64 ± 7.7 years. They were 72 females and 12 males (F:M = 6:1) with a mean BMI of 35.29 ± 4.8. Sixty patients had knee effusion which was bilateral in 54 (64.3%), unilateral in 6 (7.2%) while 24 (28.6%) did not have any effusion. Knee deformities were present in 60 (71.4%) patients. Female patients were only significantly higher than males regarding Lequesne’s index (15.08 ± 4.4 vs 11 ± 3.4, p = 0.003). Patients with knee deformity had significantly higher VAS (9.12 ± 1.3 vs 6.96 ± 0.46, p = 0.001), IL1β (621.1 ± 98.8 vs 503.9 ± 74.6 pg/ml, p = 0.001), TNF-α (115.4 ± 29.1 vs 87.4 ± 4.4 pg/ml, p = 0.001), NO (67.32 ± 5.7 vs 59.2 ± 2.2 μmol/L, p = 0.001), MMP13 (33.98 ± 2.24 vs 30.1 ± 1.7 ng/ml, p = 0.012) and leptin (13.2 ± 1.6 vs 10.4 ± 0.6, p = 0.004) than those without. The VAS, Lequesne index, IL1β, TNF-α NO, MMP13 and leptin were significantly higher in patients with bilateral knee effusion (p < 0.0001 for all) compared to those with unilateral effusion or without. Leptin significantly correlated with BMI, VAS, Lequesne’s index, IL1β, TNFα, NO and MMP13 (p < 0.0001 for all).ConclusionLeptin plays a key role in obese patients with knee OA. It significantly correlates with knee pain, functional impairment, inflammatory cytokines and cartilage degradation.     

Intra-articular hyaluranic acid compared with progressive knee exercises in osteoarthritis of the knee: a prospective randomized trial with long-term follow-up

The goal of this study was to determine whether hyaluronic acid (HA) or progressive knee exercises (PE) can improve functional parameters in patients with osteoarthritis (OA) of the knee. In a prospective clinical trial 200 knees (105 patients) with radiographic Kellgren Lawrence grade III OA were randomized and received either three intra-articular injections of hyaluronic acid (Hylan G-F 20) at one-week intervals or PE for 6 weeks. Patients were evaluated by use of the Hospital for Special Surgery (HSS) Knee Score and followed-up for 18 months. Total HSS score for HA and PE patients improved from 62.6±13.8 to 88.8±11.1 and from 65.4±12.3 to 88.3±9.1, respectively, at the end of the trial (P<0.01). There were no statistically significant differences between the groups. Twenty-one patients of the HA group were excluded from the study because they had received another form of therapy. All patients in the PE group completed the trial. The patients who dropped out had also significant improvement from 57.0±12.9 to 76.7±11.9 (P<0.01). This prospective randomized trial confirmed that both HA injections and PE result in functional improvement. HA injections also increase the levels of satisfaction of the OA patients.     

Comparison of proprioceptive functions between computerized proprioception facilitation exercise and closed kinetic chain exercise in patients with knee osteoarthritis

Aim The aim of this study was to compare proprioceptive function between computerized proprioception facilitation exercise (CPFE) and closed kinetic chain exercise (CKCE) for knee osteoarthritis. Design Randomized–controlled. Setting Kinesiology laboratory. Patients Eighty-one patients with bilateral knee osteoarthritis were randomly assigned to CPFE, CKCE, and control groups. Intervention Both exercise groups underwent an 8-week program of three sessions per week. The control group received no training. The CPFE program included a 20-min computer game to be played by the trained foot of the subject. CKCE included 10 sets of 10 repetitions of repeated knee extension and flexion with resistance of 10–25% of body weight. Main outcome measures Absolute reposition error, functional score, walking speed, and knee muscle strength were assessed with an electrogoniometer, the physical function subscale of Western Ontario and McMaster Osteoarthritis Index, a CASIO stopwatch, and a Cybex 6000 dynamometer before and after the 8-week period. Results The results of this study showed that both CPFE and CKCE were effective in improving joint position sense, functional score, walking speed, and muscle strength. Furthermore, CKCE showed greater effect in increasing knee extensor torque in patients with knee osteoarthritis. Conclusion Clinical effects of CPFE were the same as those of CKCE except for knee extensor torque. The increase in knee extensor torque in CPFE patients was not as great as that seen in CKCE patients. This study was orally presented at the Annual Research Conference of Physical Therapy Association of the Republic of China, Taipei, Taiwan. September 19, 2004. An erratum to this article can be found at     

Neuropathic pain in Egyptian patients with primary knee osteoarthritis: Relationship with functional status and radiological severity

Aim of the workThe present study was conducted to identify the frequency of neuropathic pain (NP) and its relationship with functional status and radiological severity in a series of Egyptian patients with primary knee osteoarthritis (OA).Patients and methodsThe study included 165 patients with primary KOA. Visual analogue scale (VAS)-pain was estimated and the Western Ontario and McMaster (WOMAC) Universities osteoarthritis index was used for assessment of pain, stiffness and physical function, Douleur Neuropathique in 4 questions (DN4) questionnaire was used to assess NP and Kellgren-Lawrence (KL) radiological grading was used to assess OA severity.ResultsThe mean age of the patients was 53.08 ± 6.95 years, were 144 females and 21 males, 23 were employed, body mass index was 24.87 ± 1.91 and total WOMAC was 44.24 ± 16.52. The mean DN4 score was 2.81 ± 1.27. 29 (17.6%) patients had NP. The mean symptom duration was significantly longer in patients with NP (50.9 ± 14.58 months) compared to those without (36.53 ± 25.25 months) (p = 0.008). The VAS-pain and WOMAC score were significantly increased in patients with NP compared to those without (p < 0.001) while the KL was comparable. The DN4 questionnaire significantly correlated with VAS-pain at rest (r = 0.56, p = 0.002); and with WOMAC pain subscale (r = 0.38, p = 0.043).ConclusionA relevant proportion of KOA patients have NP and is remarkably related to the disease duration. Functional capacity is adversely affected in these patients. However, no relation was found between DN4 questionnaire and the radiological severity. Once detected, suitable treatment options for NP should be included in the management of primary KOA.     

悬吊技术联合Mulligan手法对膝骨关节炎老年人群运动后疼痛的康复效果

目的 探究悬吊技术联合Mulligan手法用于膝骨关节炎老年人运动后膝关节疼痛康复的效果.方法 选取84例单侧膝关节运动后疼痛的膝骨关节炎老年患者,依据随机数字表法分为观察组和对照组,各42例.对照组给予常规物理治疗与悬吊训练治疗,观察组在对照组基础上给予Mulligan技术治疗.比较两组治疗开始前与治疗后视觉模拟评分(VAS)疼痛评分、QOL-BREF评分、LEFS下肢功能评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力.结果 两组治疗后VAS评分明显降低(P<0.05),且观察组VAS评分明显低于对照组(P<0.05).两组治疗后QOL-BREF评分/LEFS评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力较治疗前明显提高(P<0.05),且治疗后观察组QOL-BREF评分/LEFS评分、膝关节功能评分、关节活动度、四头肌与腘绳肌肌力明显高于对照组(P<0.05).结论 对于膝关节运动后疼痛的膝骨关节炎老年患者,悬吊技术联合Mulligan手法,能有效缓解膝关节疼痛、促进膝关节功能恢复,提高患者生活质量.     

Plasma and synovial fluid osteopontin levels in patients with knee osteoarthritis: Relation to radiological grade

Aim of workTo investigate osteopontin (OPN) levels in both plasma and synovial fluid of patients with primary knee osteoarthritis (OA) and their relationship with radiological grade.Patient and methodsSixty patients had knee OA and 30 control subjects were included. Anteroposterior knee radiographs were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed by using the Kellgren–Lawrence grading. Osteopontin levels in the plasma and synovial fluid were measured using enzyme-linked immunosorbent assay and compared.ResultsOA patients had higher plasma osteopontin concentrations compared to healthy controls (p < 0.000). Osteopontin levels in synovial fluid were significantly higher with respect to plasma sample (r = 0.694, p < 0.000). The mean plasma levels of osteopontin in KL grade 4 were greater than those in KL grade 3, and the difference was statistically significant (p < 0.01). The plasma osteopontin levels significantly correlated with the severity of disease (r = 0.870, p < 0.000). The synovial fluid levels of osteopontin also correlated with disease severity as regarding the radiological grade (r = 0.817, p < 0.000).ConclusionOsteopontin in plasma and synovial fluid is related to progressive joint damage in knee OA. Osteopontin may serve as a biochemical marker for determining disease severity as regarding radiological grade.     

Elevated tumor necrosis factor alpha and interleukin-6 serum levels as markers for complicated Plasmodium falciparum malaria

PURPOSE: Tumor necrosis factor alpha (TNF-alpha) has been implicated in the pathology of experimental malaria. To establish its relevance to human malaria, we studied serum levels of two monocyte-derived cytokines, TNF-alpha and interleukin-6 (IL-6), as well as of the lymphocyte-derived mediator interferon gamma (IFN-gamma) in patients with malaria before and during antiparasitic treatment. PATIENTS AND METHODS: One hundred twenty serum samples of 40 patients with malaria (Plasmodium falciparum [n = 32], Plasmodium vivax [n = 8]) were analyzed. IL-6 was measured by a highly sensitive and specific bioassay, TNF-alpha by immunoradiometric assay, and IFN-gamma by radioimmunoassay. RESULTS: Elevated cytokine levels could be detected in the majority of patients with P. falciparum malaria before treatment (31 of 32, 21 of 32, and 21 of 32 for TNF-alpha, IL-6, and IFN-gamma, respectively), but only in some patients with P. vivax malaria (four of eight, one of eight, and zero of eight for TNF-alpha, IL-6, and IFN-gamma, respectively). Serum concentrations of the monokines TNF-alpha and IL-6 correlated significantly with parasitic density (p less than 0.001). No such correlation was obtained with the circulating IFN-gamma concentration. The levels of monokines TNF-alpha and IL-6 were markedly elevated in 18 P. falciparum-infected patients with complicated clinical courses (median values for TNF-alpha 172 pg/mL, for IL-6 16 U/mL, peak values: 896 pg/mL and 1,000 U/mL, respectively). The correlation between TNF-alpha and IL-6 concentrations in serum (n = 40, r = 0.56, p = 0.0002) suggests co-ordinate production of those mediators. CONCLUSION: Organ impairment in human malaria was found to be correlated with the amount of circulating cytokine levels of TNF-alpha and IL-6. Thus, imbalances of the cytokine network in untreated P. falciparum infection serve as markers of severity of disease. Modulation of cytokine response could represent a novel approach to the treatment of severe organ dysfunctions in human malaria.     

芪防膝痹方治疗老年性膝骨关节病的疗效研究

目的 观察芪防膝痹方治疗膝骨关节病的临床疗效.方法 将96例患者按随机原则分为治疗组48例、对照组48例.治疗组BID口服芪防膝痹方水煎剂150 mL,对照组QD口服塞来昔布胶囊200 mg.治疗4w后,分别以Lequesne M的膝骨关节病临床评估指数打分表对治疗前后病情严重程度打分,并进行统计分析.结果 治疗组和对照组在疗效上差异无统计学意义（P＞0.05）,治疗组LequesneM表中的各项目评分与对照组差异无统计学意义（P＞0.05）.芪防膝痹方对气滞血瘀型、肝肾不足型的疗效优于风寒湿型[（89.40±9.23）vs （80.20±13.62）,P＜0.05];[（88.70±6.26）vs （80.20±13.62）,P＜0.05],对临床中期患者的效果优于早、晚期[（92.57±2.59） vs （84.63±8.01）,P＜0.05];[（92.57±2.59）vs （83.00±13.51）,P＜0.05],对X线Ⅱ期患者的效果优于Ⅰ、Ⅲ期[（92.75±2.49）vs（84.63±8.01）,P＜0.05];[（92.75±2.49）vs （81.63±13.73）,P＜0.05].结论 芪防膝痹方在临床疗效上与塞来昔布相当,在某些期或某些功能的改善上优于塞来昔布,适合临床推广.     

Interleukin-1, interleukin-2, interleukin-4, interleukin-6, tumor necrosis factor alpha, and interferon-gamma levels in sera from patients with scleroderma.

OBJECTIVE. To determine whether interleukin-1 alpha (IL-1 alpha), IL-1 beta, IL-2, IL-4, interferon-gamma (IFN gamma), IL-6, and tumor necrosis factor alpha (TNF alpha) are detected more frequently in sera from scleroderma patients than in sera from controls. METHODS. Serum concentrations of these cytokines were measured in 78 scleroderma patients and 73 controls, using enzyme-linked immunosorbent assay, radioimmunoassay, and bioassay techniques. RESULTS. IL-2, IL-4, and IL-6 were each detected more frequently in sera from scleroderma patients than in sera from controls. TNF alpha and IL-1 alpha were found with equal frequency in patient and control sera. IL-1 beta and IFN gamma were not detected in any sera. CONCLUSION. IL-2, IL-4, and IL-6 may be among the cytokines that contribute to the disease process in scleroderma patients. To our knowledge, this is the first report of elevated serum IL-4 levels in human disease.     

一氧化氮、白介素、肿瘤坏死因子与肝硬化患者预后的关系

目的:探讨血清一氧化氮(NO)、IL-6、IL-10、肿瘤坏死因子(TNF)水平与肝硬化患者预后之间的关系.方法:采用硝酸还原酶法、ELISA法、双抗体夹心酶联免疫分析法分别测定30例健康对照者和56例肝硬化患者治疗前后的血清NO,IL-6,IL-10及TNF水平.结果:肝硬化患者的NO,IL-6,TNF水平显著升高,IL-10水平明显降低.治疗后肝功能减退组的NO (129.21±27.32μmol/L vs 92.18±25.68μmol/L,P<0.05)、IL-6(198.5±23.2 mg/L vs 147.0±19.1 mg/L,P<0.05)、TNF(179.2±23.5 pg/dL vs 121.4±17.5 pg/ dL,P<0.05)水平较治疗前有显著升高,IL-10水平则明显下降(33.4±7.2 mg/L vs 51.6±18.5 mg/L,P<0.05),而治疗后肝功能恢复组NO(58.63±12.25μmol/L vs 94.36±23.45μmol/L,P<0.05)、IL-6(90.3±12.7 mg/ L vs 148.5±15.8 mg/L,P<0.05)、TNF(78.2±14.3 pg/dL vs 124.9±20.1 pg/dL,P<0.05)水平较治疗前降低(P<0.05),IL-10水平则明显升高(89.3±18.9 mg/L vs 48.8±9.5 mg/L,P<0.05).结论:NO,IL-6,IL-10,TNF与肝硬化患者预后有关.     

Quality of life and self-reported disability in patients with knee osteoarthritis

Abstract

Objectives Osteoarthritis (OA) is the most common degenerative joint disorder and a major public health problem throughout the world. The aims of this study are to assess quality of life (QoL) in patients with knee OA using the generic instrument Short Form-36 (SF-36) and to determine its relationships with conventional clinical measures and self-reported disability.

Methods Patients with knee OA (n = 112) with median age of 60 (45–76) years and 40 sex- and age-matched healthy controls were included in the study. Age, sex, body mass index (BMI), symptom duration, and Kellgren–Lawrence scores were recorded. QoL, disability, and pain were assessed using the SF-36, the Western Ontario and McMaster (WOMAC) index, the Lequesne index, and a visual analog scale (VAS) in patients. Also, QoL was assessed using the SF-36 in controls.

Results Patients with knee OA had lower scores in all subgroups of SF-36 compared with controls. In patients, the SF-36 physical function (PF) and pain areas significantly correlated with effusion, VAS pain, and Lequesne and WOMAC subgroup scores (p < 0.05). The pain area of QoL did not show correlation with comorbidity with knee OA. We found that SF-36 and WOMAC pain scores were more severe in female patients.

Conclusions Patients with knee OA had significantly poorer QoL compared with healthy controls. SF-36 is related to the clinical status and functional ability of patients with OA and can be used as a sensitive health status measure for clinical evaluation. Also WOMAC can be used as a sensitive measure for disability of patients with knee OA.     

Vitamin D deficiency in Egyptian and Yemeni primary knee osteoarthritis patients: Relation to physical function and radiographic severity

Aim of the workTo investigate the relationship between serum 25(OH)D (25-hydroxyvitamin D) level and primary knee osteoarthritis (KOA) in Egyptian and Yemeni patients, and to demonstrate its impact on physical function and radiographic severity.Patients and methodsThis study included 82 KOA patients; (41 Egyptian, 41 Yemeni), together with 80 controls; (40 Egyptian, 40 Yemeni). Serum 25(OH)D level was measured using enzyme-linked immunosorbent assay. Physical function was evaluated using 6-minute walk test (6MWT), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score and chair stand test (CST). Knee radiographic grading was based on Kellgren-Lawrence (KL) scale.ResultsThe mean age of Egyptian and Yemeni patients was 53.4 ± 7.1 and 56.2 ± 7.5 years respectively. Serum 25(OH)D level was significantly decreased in Egyptian (13.3 ng/ml;5.3–39.6) and Yemeni (9.5 ng/ml; 3.8–49) KOA patients compared to their corresponding controls (27.7 ng/ml; 12.8–51.4 and 20.9 ng/ml; 8–45.5; p < 0.001 each) and was the only significant predictor of KOA in Egyptian (p < 0.0001) and Yemeni (p = 0.001) patients. Yemeni patients exhibited significantly lower 25(OH)D compared to Egyptian patients (p = 0.008) with a significant increase in smoking (p = 0.002) and niqab wearing (p < 0.001). Serum 25(OH)D level significantly negatively correlated with radiographic grading in Egyptian (p = 0.03) and Yemeni (p = 0.02) patients. Regression analysis showed no relationship between 25(OH)D levels with WOMAC, 6MWT or CST; the relation was significant with KL grading in Egyptian (p = 0.01) and Yemeni (p = 0.005) patients.ConclusionThere is an association between vitamin D deficiency and primary KOA especially to the radiographic severity but not to physical function in Egyptian or Yemeni primary KOA patients.     

Elevated synovial fluid levels of interleukin-6 and tumor necrosis factor associated with early experimental canine osteoarthritis

Objective. To measure levels of cytokines, proteases, and glycosaminoglycans (GAG) in synovial fluid (SF) from the knees of animals with experimental osteoarthritis (OA) and from their contralateral (control) knees, and to compare and correlate these values with each other as well as with measures of proteoglycan synthesis in the corresponding articular cartilage. This study will help to identify cytokines of potential importance in the early stages of the development of OA. Methods. OA was induced in 12 mature animals by sectioning the anterior cruciate ligament. After 3 months, SF from the operated and contralateral (control) knee joints was assayed for interleukin-6 (IL-6), tumor necrosis factor (TNF), IL-1, latent metalloproteinase, and sulfated GAG. Proteoglycan synthesis in the corresponding articular cartilage was also measured. Results. IL-6 levels in SF from the operated joint compared with the control joint were significantly elevated in 11 of 12 animals. TNF levels were also elevated in 10 of 11 SF samples from operated joints, but to a lesser extent than those of IL-6. IL-1 and IL-1 inhibitors were undetectable in either the operated or control joint SF. The GAG concentration was elevated in SF from experimental OA joints. This elevation correlated with that of TNF, but not IL-6. There was no significant difference in the concentration of APMA-activatable metalloproteinase. The rate of proteoglycan synthesis was higher in the cartilage from the operated joint in 8 of 12 animals, and the mean rate of synthesis was significantly higher than in the control joint. There was a positive correlation between this increase in cartilage proteoglycan synthesis (operated versus control) and the increase in SF IL-6, but there was no correlation with the levels of TNF or GAG. Conclusion. This is the first study of SF levels of cytokines in early experimental OA. Our results show surprisingly high levels of IL-6 in operated joints, where the cytokine could act directly on the chondrocytes, and thus play a role in mediating their responses to cartilage injury.     

Genetic polymorphism of interleukin-16 and its association with the clinical and radiographic severity in primary knee osteoarthritis patients

Aim of the workTo investigate the association between IL and 16 genetic (rs4072111) single nucleotide polymorphism (SNP) and susceptibility to primary knee osteoarthritis (KOA) and to elaborate its connection with clinical and radiographic severity of KOA.Patients and methods80 primary KOA patients and 35 matched healthy controls. IL-16 gene rs4072111 SNP was genotyped in KOA patients and control using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) technique and verified by direct DNA sequencing. Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to assess the clinical severity of KOA and Kellgren lawrence (K/L) radiographic grading was evaluated.ResultsThe 80 KOA patients were 60 female and 20 male patients with mean of 55.8 ± 8.9 years (38–71 years), BMI 25.5 ± 1.8 (16.5–27) and disease duration 5.8 ± 4.3 years (1–20 years). The mean WOMAC index was 52.9 ± 17.9 and the K/L score was 2.49 ± 0.73. Patients carrying the wild (CC) genotype had a significantly higher WOMAC index compared those carrying the TT and CT genotypes (p = 0.0.046) also, KL sore had tendency to increase in patient carrying the wild (CC) compared to patients carrying the TT and CT genotypes (p = 0.08), However, no direct genetic association was detected between the SNP and KOA. On performing a regression with WOMAC as the dependant factor only the triglycerides (p = 0.001) and K/L (p < 0.0001) were independent risk factors.ConclusionIl-16 gene (rs4072111) SNP might be associated with clinical severity of KOA. Furthermore, the SNP is not likely to be associated with KOA susceptibility in the Egyptian population.     

Role of serum adropin as a novel biomarker in primary knee osteoarthritis patients: Relation to the functional status,radiographic grading and ultrasonographic findings

BackgroundKnee osteoarthritis (KOA) may lead to disabilities and affect work and daily activities. There is no specific blood test for its early diagnosis. Serum adropin is however a promising biomarker.Aim of the workTo determine the levels of serum adropin in primary KOA andassess its relation with the different radiographic grades of the disease.Patients and methodsA total of 40 primary KOA patients (64 affected knees) and 20 healthy control participated in this study. KOA grades was assessed using ultrasonography (US) and X-ray according to KL grading system. Serum adropin levels were measured.ResultsKOA was bilateral in 24 (60%) patients and knee effusion was present in 46 knees (71.9%). Serum adropin level in KOA patients (46.3 ± 27.9 pg/ml) was significantly lower than in controls (76.5 ± 27.2 pg/ml) (p < 0.00001). Serum adropin was lower in females than in males in patients (40.2 ± 17.7 pg/ml vs 75.2 ± 47.2 pg/ml; p = 0.0016). Serum adropin has significant negative correlation with the KL radiographic grading (r = -0.54, p = 0.0003).At cut off value of 54 and an AUC = 0.85, serum adropin could significantly distinguish between patients and controls (p < 0.05) at a sensitivity of 80%, specificity 90%.ConclusionsSerum adropin levels were significantly low in KOA patients with specificity of 90% and sensitivity of 80%, with a negative significant correlations with the degree of radiographic severity evaluated by KL grading scale and ultrasound. These findings suggest that low serum adropin levels could be a sensitive and specific test for the detection of KOA.     

血甘油三酯、尿酸对非酒精性脂肪性肝病患者血清肿瘤坏死因子α、白介素6及胰岛素抵抗的影响

目的观察血甘油三酯(TG)、尿酸(UA)对非酒精性脂肪性肝病(NAFLD)患者血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)及胰岛素抵抗(IR)的影响。方法从我院就诊经彩色超声诊断的脂肪肝患者中,依血TG水平分为3组,即血TG正常组(NT)、仅血TG升高组(HT组)、血TG合并UA升高组(HTU组),以血TG正常的非脂肪肝人群做对照组(Control)。测各组血清胰岛素、TNF-α、IL-6、血糖,以胰岛素抵抗指数(HOMA-IR)评价IR。结果与Control相比,NT、HT组TNF-α、IL-6、HOMA-IR均无明显增高(P>0.05);HTU组IL-6及HOMA-IR明显增高[IL-6,HTU:135.19(90.27～164.24)ng/mL vs Control:61.6(53.53～79.69)ng/mL;HOMA-IR,HTU:2.34±0.53 vs Control:1.00±0.81,P<0.01],TNF-α无明显增高(P>0.05);相关分析表明,血TG与HO-MA-IR呈明显正相关(r=0.428,P<0.01)。结论 NAFLD患者是否发生IR及IL-6、TNF-α的变化可能受不同TG水平的影响。     

Plasma levels of tumor necrosis factor alpha and soluble tumor necrosis factor receptors in patients with narcolepsy

BACKGROUND: Narcolepsy is a disabling sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis. Recent studies suggest that the immune system might play a pathogenic role pointing to a possible involvement of inflammatory cytokines. METHODS: We investigated a sample of 30 patients with narcolepsy in comparison with 120 sex- and age-matched and 101 sex-, body mass index (BMI)-, and age-matched randomly selected normal controls. In these groups, plasma concentrations of tumor necrosis factor alpha (TNF-alpha) and its soluble receptors p55 and p75 (soluble TNF receptor [sTNF-R] p55 and sTNF-R p75) were measured using commercial enzyme-linked immunosorbent assays. RESULTS: The narcoleptic patients showed a significantly higher BMI compared with controls of the same age. Soluble TNF-R p75 levels were consistently elevated in the narcoleptic patients compared with their sex- and age-matched (P = .001) as well as sex-, BMI-, and age-matched counterparts (P = .003). Female narcoleptic patients exhibited higher sTNF-R p55 levels compared with their sex- and age-matched controls (P = .01), but this difference disappeared when comparing patients with sex-, BMI-, and age-matched normal controls. Tumor necrosis factor alpha levels did not differ significantly between groups. CONCLUSION: Narcoleptic patients show increased plasma levels of sTNF-R p75, suggesting a functional alteration of the TNF-alpha cytokine system, further corroborating a possible pathogenic role of the immune system in this sleep disorder.