原发性膝骨关节病中血清相关生物标志物的表达

背景：近年来随着分子生物学的不断发展,反映关节软骨早期退变等有关病理变化的实验室指标已是研究的热点问题。目的：探讨C-末段交叉连接的Ⅱ型胶原和软骨寡聚基质蛋白在原发性膝骨关节病患者中的临床意义,寻求原发性膝骨关节病特征规律与C-末段交叉连接的Ⅱ型胶原和软骨寡聚基质蛋白的相关性。方法：纳入膝骨关节病组患者70例,健康志愿者18例设为对照组,采用酶联免疫夹心法检测两组血清中C-末段交叉连接的Ⅱ型胶原和软骨寡聚基质蛋白的水平。结果与结论：原发性膝骨关节病患者血清中C-末段交叉连接的Ⅱ型胶原和软骨寡聚基质蛋白均明显高于对照组,进一步深入研究发现在不同的性别、年龄及X射线的变化中均存在显著性差异,不同中医证型中风寒湿痹型患者C-末段交叉连接的Ⅱ型胶原明显低于肝肾亏虚型和气滞血瘀型患者,而软骨寡聚基质蛋白间比较差异无显著性意义。说明C-末段交叉连接的Ⅱ型胶原和软骨寡聚基质蛋白与膝骨关节炎的发生发展有着密切关系,两者联合应用能显著提高诊断的准确性,在膝骨关节炎的发病机制中具有重要的作用,与软骨的退变密切相关,并且可以反映病情、证型等变化。     

复方夏天无片联合盐酸氨基葡萄糖治疗早中期膝关节骨性关节炎的初步探讨

目的 研究复方夏天无片在早中期膝关节骨性关节炎中的临床疗效和安全性。方法 本研究将2010年8月至2011年2月间120例患者分为2组。实验组用复方夏天无片联合盐酸氨基葡萄糖,对照组单纯用盐酸氨基葡萄糖,治疗半年后采用Lequensne指数作为疗效评分标准,观察治疗前后膝关节症状,比较2组之间膝关节症状及不良反应。结果 随访3个月,实验组和对照组的疗效相比较,差异无统计学意义(P>0.05);但随访半年后,2组相比疗效差异有统计学意义(P<0.05)。2组的不良反应相比无统计学意义(P>0.05)。结论 本研究表明复方夏天无片联合盐酸氨基葡萄糖在治疗早中期膝关节骨性关节炎症状改善优于单纯使用盐酸氨基葡萄糖。复方夏天无片不良反应小、安全性高,对于膝关节骨关节炎具有较好的疗效。     

复方南星止痛膏联合玻璃酸钠治疗膝关节骨性关节炎25例

目的探讨复方南星止痛膏配合玻璃酸钠对膝关节骨性关节炎的疗效。方法将门诊骨关节炎患者75例（Ahlback1级）随机分成3组,每组25例。A组接受膝关节腔玻璃酸钠注射和复方南星止痛膏外敷,B组只接受膝关节腔玻璃酸钠注射,C组只接受复方南星止痛膏外敷。观察3组视觉模拟评分、西安大略和麦克马斯特大学骨关节炎调查量表（WOMAC）指数和中医证候,用以评价治疗效果。结果治疗后3组临床各项评分较治疗前均显著好转（P〈0．05）,其中A组好转,较B组、C组具有显著性（P〈0．05）,B组和C组之间无统计学差异（P〉0．05）。结论玻璃酸钠膝关节腔注射配合复方南星止痛膏外敷,较单用玻璃酸钠或复方南星止痛膏,对膝关节骨关节炎的治疗有更好的效果。     

骨关节炎患者血清和关节液一氧化氮及其合成酶变化的意义

目的探讨骨关节炎(OA)患者血清及关节液中一氧化氮(NO)和诱生型一氧化氮合成酶(iNOS)与病情程度及活动性的关系.方法对30例轻度(n=7)、中度(n=12)、重度(n=11)骨关节炎患者及24例健康对照者血清及关节液中NO、iNOS、ESR、CRP的含量进行测定.结果中、重度骨关节炎组血清中NO、iNOS水平比健康组升高(P＜0.01);三组骨关节炎关节液中NO、iNOS水平均比对照组明显升高(P＜0.001);重度骨关节炎组血清中NO、iNOS水平与关节液中NO、iNOS水平呈正相关(r=0.589,P＜0.01);重度骨关节炎组关节液中NO、iNOS水平与ESR、CRP呈正相关(r=0.428,p＜0.05).结论iNOS及其产生的NO参与了OA的病变过程,是OA病程发展的重要机制.     

Haem oxygenase-1 regulates catabolic and anabolic processes in osteoarthritic chondrocytes

Pro-inflammatory cytokines, matrix metalloproteinases (MMPs) and other catabolic factors participate in the pathogenesis of cartilage damage in osteoarthritis (OA). Pro-inflammatory cytokines such as interleukin-1beta (IL-1beta) mediate cartilage degradation and might be involved in the progression of OA. Previously, we found that haem oxygenase-1 (HO-1) is down-regulated by pro-inflammatory cytokines and up-regulated by IL-10 in OA chondrocytes. The aim of this study was to determine whether HO-1 can modify the catabolic effects of IL-1beta in OA cartilage and chondrocytes. Up-regulation of HO-1 by cobalt protoporphyrin IX significantly reduced glycosaminoglycan degradation elicited by IL-1beta in OA cartilage explants but increased glycosaminoglycan synthesis and the expression of collagen II in OA chondrocytes in primary culture, as determined by radiometric procedures, immunoblotting and immunocytochemistry. HO-1 decreased the activation of extracellular signal-regulated kinase 1/2. This was accompanied by a significant inhibition in MMP activity and expression of collagenases MMP-1 and MMP-13 at the protein and mRNA levels. In addition, HO-1 induction caused a significant increase in the production of insulin-like growth factor-1 and a reduction in the levels of insulin-like growth factor binding protein-3. We have shown in primary culture of chondrocytes and articular explants from OA patients that HO-1 counteracts the catabolic and anti-anabolic effects of IL-1beta. Our data thus suggest that HO-1 may be a factor regulating the degradation and synthesis of extracellular matrix components in OA.     

Are the kinematics of the knee joint altered during the loading response phase of gait in individuals with concurrent knee osteoarthritis and complaints of joint instability? A dynamic stereo X-ray study

Background

Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional decline in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear.

Methods

Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait.

Findings

Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P < 0.01), while the total abduction/adduction range of motion was increased (P < 0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P < 0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait.

Interpretations

The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics.     

Muscle mass and composition of the hip, thigh and abdominal muscles in women with and without hip osteoarthritis

The objective of this study was to compare muscle mass and composition between individuals with and without hip osteoarthritis. Twenty-four women with hip osteoarthritis (OA group) and 16 healthy women (healthy group) participated in this study. Muscle thickness (MT) and echo intensity (EI) were measured as indices of muscle mass and composition, respectively, using ultrasound imaging. Seven muscles were examined: gluteus maximus, gluteus medius, quadriceps femoris, rectus abdominis, external oblique, internal oblique and transversus abdominis. MT of only quadriceps femoris in the OA group was significantly thinner than that in the healthy group. EIs of gluteus medius, quadriceps femoris and rectus abdominis were significantly higher in the OA group than those in the healthy group. Thus, actual contractile tissue of gluteus medius and rectus abdominis substantially decreased, although muscle mass was similar, whereas both quantitative and qualitative changes occurred in quadriceps femoris in patients with hip OA.     

Existence of a neuropathic pain component in patients with osteoarthritis of the knee

Purpose

Pain from osteoarthritis (OA) is generally classified as nociceptive (inflammatory). Animal models of knee OA have shown that sensory nerve fibers innervating the knee are significantly damaged with destruction of subchondral bone junction, and induce neuropathic pain (NP). Our objective was to examine NP in the knees of OA patients using painDETECT (an NP questionnaire) and to evaluate the relationship between NP, pain intensity, and stage of OA.

Materials and Methods

Ninety-two knee OA patients were evaluated in this study. Pain scores using Visual Analogue Scales (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), painDETECT, duration of symptoms, severity of OA using the Kellgren-Lawrence (KL) system, and amount of joint fluid were evaluated and compared using a Spearman''s correlation coefficient by rank test.

Results

Our study identified at least 5.4% of our knee OA patients as likely to have NP and 15.2% as possibly having NP. The painDETECT score was significantly correlated with the VAS and WOMAC pain severity. Compared with the painDETECT score, there was a tendency for positive correlation with the KL grade, and tendency for negative correlation with the existence and amount of joint fluid, but these correlations were not significant.

Conclusion

PainDETECT scores classified 5.4% of pain from knee OA as NP. NP tended to be seen in patients with less joint fluid and increased KL grade, both of which corresponded to late stages of OA. It is important to consider the existence of NP in the treatment of knee OA pain.     

骨刺胶囊治疗膝关节骨性关节炎疗效观察

目的 观察骨刺胶囊治疗膝关节骨性关节炎的疗效。方法 将122例膝关节骨性关节炎患者随机分为两组：治疗组62例,对照组60例。治疗组给予骨刺胶囊治疗,对照组给予芬必得治疗。比较两组治疗前后膝关节功能评分,观察主要症状缓解情况。结果 治疗组总有效率为95.16%,对照组总有效率为80.0%,两组疗效比较差异显著（P＜0.05)。结论 骨刺胶囊治疗骨性关节炎有较好疗效。     

生物力学敷贴吡罗昔康治疗膝骨关节炎研究

目的观察生物力学辨证下吡罗昔康贴片治疗膝骨关节炎的临床疗效,并探讨其作用机制。方法将膝骨关节炎患者100例随机分成治疗组和对照组,每组50例,治疗组按生物力学辨证敷贴吡罗昔康贴片于治疗点,对照组给予扶他林乳胶剂,连续用药12周。观察治疗前后靶部位的VAS评分、体征等指标及总体评价。结果治疗组总有效率为90％,对照组总有效率为70％;在功能改善及缓解疼痛情况方面,两组经统计学处理差异有统计学意义（P〈0．05）,治疗组明显优于对照组。结论吡罗昔康贴片在改善患者症状体征、提高生活质量方面及减轻疾病活动性方面都具有良好的疗效,并且毒副作用和不良反应小,具有一定的临床应用前景。