本文選題：膝骨關(guān)節(jié)炎 + 關(guān)節(jié)��； 參考：《安徽醫(yī)科大學(xué)》2015年碩士論文

【摘要】：背景骨關(guān)節(jié)炎(Osteoarthritis,OA)是全球最常見的慢性關(guān)節(jié)疾病,是中老年人殘疾的主要原因。目前,通過放射學(xué)檢查即X線,已成為臨床上診斷OA的金標(biāo)準(zhǔn),通過X線不能觀察到OA早期關(guān)節(jié)結(jié)構(gòu)改變,這對OA的早期診斷及治療帶來一定程度的困難。磁共振成像(Magnetic Resonance Imaging,MRI)可發(fā)現(xiàn)早期、細(xì)微的結(jié)構(gòu)改變,因此,MRI越來越多應(yīng)用到關(guān)節(jié)疾病的早期診斷及治療中。近年來,國外有研究證明關(guān)節(jié)軟骨容積(Cartilage Volume,CV)與OA放射學(xué)改變包括骨贅(Osteophyte,OP)和關(guān)節(jié)間隙狹窄(Joint Space Narrowing,JSN)及其它關(guān)節(jié)結(jié)構(gòu)改變相關(guān),此類研究在我國鮮有報道。肥胖所致關(guān)節(jié)過度承重是導(dǎo)致膝OA關(guān)節(jié)結(jié)構(gòu)改變的機(jī)制之一,近年來研究表明,脂肪組織可分泌多種脂肪細(xì)胞因子,如瘦素(Leptin,LPT)、脂聯(lián)素(Adiponectin,ADP)、抵抗素(Resistin,RST)等,參與膝OA的發(fā)生發(fā)展,但膝OA患者關(guān)節(jié)結(jié)構(gòu)的改變與脂肪細(xì)胞因子的作用及臨床意義國內(nèi)尚未見系統(tǒng)性報道。目的分析CV與放射學(xué)改變、軟骨缺損(Cartilage Defects,CD)、骨髓病變(Bone Marrow Lesions,BMLs)等結(jié)構(gòu)改變及與血清脂肪細(xì)胞因子、實驗室指標(biāo)的相關(guān)性,以提高對OA的認(rèn)識,探索可能的早期診斷指標(biāo)和潛在的治療靶點(diǎn)。方法收集2012年1月至2013年11月就診于安徽醫(yī)科大學(xué)第一附屬醫(yī)院風(fēng)濕科門診的癥狀性膝OA患者205例。根據(jù)X線,使用凱爾格倫-勞倫斯(Kellgren-Lawrence,KL)對患者膝關(guān)節(jié)放射學(xué)改變嚴(yán)重程度進(jìn)行評級及使用OA研究協(xié)會(Osteoarthritis Research Society International,OARSI)分級標(biāo)準(zhǔn)評估OP、JSN的分級。使用Osiri X軟件在MRI測量CV,并評估CD、BMLs的分級。記錄患者的臨床及實驗室指標(biāo),根據(jù)西安大略和麥克瑪斯特大學(xué)OA指數(shù)評分表(TheWestern Ontario and Mc Master University Osteoarthritis Index,WOMAC)對患者膝關(guān)節(jié)疼痛、僵硬、關(guān)節(jié)功能進(jìn)行評分。用酶聯(lián)免疫吸附法(Enzyme-linked Immunosorbent Assay,ELISA)檢測患者血清LPT、ADP、RST水平。結(jié)果1.膝關(guān)節(jié)CV與臨床及實驗室指標(biāo)的相關(guān)性:總CV(髕骨、內(nèi)側(cè)脛骨、外側(cè)脛骨CV之和)僅與WHR有明顯正相關(guān)(r=0.172,P=0.033);男、女之間CV(髕骨、內(nèi)側(cè)脛骨、外側(cè)脛骨)有明顯的差異性,P值均0.05;有放射學(xué)改變與無放射學(xué)改變兩組間的年齡、病程、總CV、髕骨CV有明顯差異性(P值分別為0.003、0.003、0.026、0.028);2.膝關(guān)節(jié)CV與放射學(xué)改變的相關(guān)性:髕骨CV在外側(cè)股、脛骨OP組間有明顯差異性,內(nèi)側(cè)脛骨CV在內(nèi)側(cè)股脛骨JSN組間有明顯差異性,內(nèi)側(cè)及外側(cè)脛骨CV在外側(cè)股脛骨JSN組間有明顯差異性(P值均0.05);以CV為因變量(髕骨、內(nèi)側(cè)脛骨、外側(cè)脛骨),以放射學(xué)改變?nèi)鐑?nèi)側(cè)股脛骨OP、內(nèi)側(cè)JSN、外側(cè)JSN分別為自變量,進(jìn)行回歸分析,調(diào)節(jié)混雜因素前后,顯示髕骨CV在外側(cè)股脛骨OP負(fù)相關(guān)(β:-0.103,95%CI:-0.165,-0.040),內(nèi)側(cè)JSN與內(nèi)側(cè)脛骨CV負(fù)相關(guān)(β:-0.090,95%CI:-0.171,-0.009),外側(cè)JSN與外側(cè)脛骨CV負(fù)相關(guān)(β:-0.125,95%CI:-0.219,-0.030),P值均0.05;3.膝關(guān)節(jié)CV與關(guān)節(jié)CD的相關(guān)性:分別對CV在不同部位(髕骨、內(nèi)側(cè)股骨、外側(cè)股骨、內(nèi)側(cè)脛骨、外側(cè)脛骨)的CD組間的差異性進(jìn)行比較,結(jié)果發(fā)現(xiàn),除了在外側(cè)股骨CD組間未發(fā)現(xiàn)CV有明顯的差異性,余均能在相應(yīng)部位的CD組間的CV發(fā)現(xiàn)明顯差異性(P值均0.05);以關(guān)節(jié)CV為因變量(髕骨、內(nèi)側(cè)脛骨、外側(cè)脛骨),以各部位的CD分別為自變量,進(jìn)行回歸分析,調(diào)節(jié)混雜因素前后,顯示特定部位的關(guān)節(jié)CV與CD負(fù)相關(guān),如調(diào)節(jié)混雜因素后,內(nèi)側(cè)脛骨CV與內(nèi)側(cè)脛骨CD負(fù)相關(guān)(β:-0.114,95%CI:-0.163~-0.064);4.膝關(guān)節(jié)CV與BMLs的相關(guān)性:內(nèi)側(cè)脛骨CV在相應(yīng)部位的BMLs分組間有顯著性差異;以CV為因變量(內(nèi)側(cè)脛骨、外側(cè)脛骨),以外側(cè)股骨、外側(cè)脛骨、內(nèi)側(cè)股骨、外側(cè)股骨BMLs分別為自變量,進(jìn)行回歸分析,調(diào)節(jié)混雜因素前后,發(fā)現(xiàn)內(nèi)側(cè)脛骨CV與內(nèi)側(cè)脛骨BMLs負(fù)相關(guān)(β:-0.042,95%CI:-0.119,-0.024);5.膝關(guān)節(jié)CV與脂肪細(xì)胞因子的相關(guān)性:放射學(xué)改變和無放射學(xué)改變的患者的血清的LPT、ADP、RST分別作為因變量,以各部位CV分別作為自變量,進(jìn)行單因素分析,結(jié)果提示,在有放射學(xué)改變的患者中LPT與髕骨、內(nèi)側(cè)脛骨CV呈明顯正相關(guān)性,在調(diào)節(jié)年齡、性別、BMI及病程后,此相關(guān)性仍存在(β:10.172,95%CI:1.30 to 17.55;β:6.213,95%CI:2.11 to 10.10);6.脂肪細(xì)胞因子與OA放射學(xué)改變嚴(yán)重程度的相關(guān)性:分別以LPT、ADP、RST作為因變量,以KL分級作為自變量,進(jìn)行線性回歸分析,調(diào)整混雜因素前后,ADP與KL分級存在負(fù)相關(guān)性(OR:0.988,95%CI:0.979 to 0.998),LPT、RST與KL分級均無明顯相關(guān)性;結(jié)論1.膝OA患者中,關(guān)節(jié)CV與其他關(guān)節(jié)結(jié)構(gòu)改變明顯相關(guān),它可能作為一個較好的臨床指標(biāo)來預(yù)測關(guān)節(jié)結(jié)構(gòu)的改變;2.在脂肪細(xì)胞因子中,LPT及ADP可能對OA起保護(hù)作用;
[Abstract]:Osteoarthritis (OA) is the most common chronic joint disease in the world. It is the main cause of disability in the middle and old people. At present, by radiological examination, X-ray has become the gold standard for clinical diagnosis of OA. The structural changes of the joint in early OA can not be observed by X-ray. This has brought about a certain degree of difficulties in the early diagnosis and treatment of OA. It is difficult. Magnetic Resonance Imaging (MRI) can detect early and subtle structural changes. Therefore, MRI is increasingly used in the early diagnosis and treatment of joint disease. In recent years, foreign studies have shown that cartilage volume (Cartilage Volume, CV) and OA radiological changes include osteophyte (Osteophyte, OP) and joint space stenosis (Cartilage, OP). Joint Space Narrowing, JSN) and other joint structural changes are related. This kind of study is rarely reported in China. Obesity - induced joint overload is one of the mechanisms that lead to the structural changes of the knee joint. In recent years, studies have shown that adipose tissue can secrete a variety of adipocytokines, such as Leptin (LPT), adiponectin (Adiponectin, ADP), resistin (Joint). Resistin, RST), etc., participate in the development of knee OA, but there is no systematic report on the changes of joint structure and the role and clinical significance of Adipocyte Factor in knee OA patients. Objective to analyze the structural changes of CV and radiological changes, cartilage defect (Cartilage Defects, CD), bone marrow lesions (Bone Marrow Lesions, BMLs) and so on. The correlation of cell factors and laboratory indicators to improve the understanding of OA, explore possible early diagnostic indicators and potential therapeutic targets. Methods 205 patients with symptomatic knee OA from January 2012 to November 2013 in the Department of rheumatism, the First Affiliated Hospital of Medical University Of Anhui were collected, and Kell Glen Laurence (Kellgren-La) was used according to X ray. Wrence, KL) rating the severity of the knee joint radiology and using the OA Research Association (Osteoarthritis Research Society International, OARSI) grading standard to evaluate the classification of OP, JSN. The Mike mast University OA index score (TheWestern Ontario and Mc Master University Osteoarthritis Index, WOMAC) was used to evaluate the pain, stiffness and joint function of the knee joint. Correlation of laboratory indicators: the total CV (the patella, medial tibia, and the CV of the lateral tibia) was only positively correlated with WHR (r=0.172, P=0.033), and there were significant differences in CV (patella, medial tibia, lateral tibia) between men and women, and the P value was 0.05; there was a significant difference between the age of the two groups, the course of the disease, the total CV, and the patellar CV between the radiological changes and the radiological changes. The sex (P value was 0.003,0.003,0.026,0.028); 2. knee joint CV and radiological changes: the patellar CV in the lateral femoral, the tibial OP group was significantly different, the medial tibial CV in the medial tibial JSN group was significantly different, the medial and lateral tibial CV in the lateral tibial JSN group was significantly different (P value was 0.05); CV as the dependent variable. (patella, medial tibia, lateral tibia), with radiological changes such as the medial tibia OP, medial JSN, and lateral JSN as independent variables, regression analysis, before and after the adjustment of the confounding factors, showing the OP negative correlation of the patellar CV in the lateral tibia (beta: -0.103,95%CI:-0.165, -0.040), and the negative correlation between the medial JSN and the medial tibia (beta: -0.090,95%CI:-0.171, -0.009). The negative correlation between lateral JSN and lateral tibia (beta: -0.125,95%CI:-0.219, -0.030), P value of 0.05, and the correlation between CV and joint CD in 3. knee joints: the differences in the CD groups of CV at different parts (patella, medial femur, lateral femur, medial tibia and lateral tibia) were compared. The results showed that CV was not found between the lateral femur CD groups. A significant difference was found in the CV of the corresponding CD groups (P value 0.05). The joint CV was used as the dependent variable (patella, medial tibia, the lateral tibia), and the CD of each part was the independent variable. The regression analysis showed that the joint CV in the specific site was negatively correlated with CD, such as after adjusting the confounding factors, The negative correlation between the medial tibial CV and the medial tibial CD (beta: -0.114,95%CI:-0.163~-0.064), and the correlation between CV and BMLs in the 4. knee joints: the CV in the medial tibia was significantly different between the BMLs groups in the corresponding parts; the independent variable (the medial tibia, the lateral tibia), the lateral femur, the lateral tibia, the medial femur, and the lateral femur BMLs were the independent variables, respectively. The negative correlation between the medial tibial CV and the BMLs of the medial tibia (beta: -0.042,95%CI:-0.119, -0.024) was found before and after the adjustment of the confounding factors. 5. the correlation between CV and adipocytokines in the knee joint: the serum LPT, ADP, RST of the patients with radiological and radiological changes were used as the dependent variables, respectively, as independent variables. Single factor analysis showed that LPT had a significant positive correlation with the patellar and medial tibial CV in patients with radiological changes. This correlation still existed after regulating age, sex, BMI, and the course of disease (beta: 10.172,95%CI:1.30 to 17.55; beta: 6.213,95%CI:2.11 to 10.10); 6. the correlation between adipocytokines and OA radiological changes: LPT, ADP and RST were used as dependent variables, and KL classification was used as independent variable and linear regression analysis was carried out. Before and after the adjustment of mixed factors, there was negative correlation between ADP and KL classification (OR:0.988,95%CI:0.979 to 0.998), LPT, RST and KL classification. As a good clinical indicator to predict changes in joint structure; 2. in LPT, ADP and OA may play a protective role in adipocytokines.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R684.3

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