急诊科膝关节滑膜炎患者抽取的滑液的润滑能力。

Lubricating ability of aspirated synovial fluid from emergency department patients with knee joint synovitis.

作者信息

Jay Gregory D, Elsaid Khaled A, Zack Jeffrey, Robinson Kristine, Trespalacios Flor, Cha Chung-Ja, Chichester Clinton O

机构信息

Department of Medicine, Brown University School of Medicine, Rhode Island 02903, USA.

出版信息

J Rheumatol. 2004 Mar;31(3):557-64.

PMID:14994405

Abstract

OBJECTIVE

To determine if joint effusions encountered in the emergency department (ED) requiring arthrocentesis possess normal lubricating ability or evidence cartilage degeneration. Chondroprotection of articulating joint surfaces is provided by lubricin, a mucinous glycoprotein that is a product of megakaryocyte-stimulating factor gene (GenBank U70136) expression. Loss of synovial fluid's (SF) lubricating ability has been implicated in the pathogenesis of degenerative joint disease.

METHODS

A retrospective ED observational study from May 1, 1999, to October 1, 2000, of adult and pediatric patients presenting with radiographically negative knee joint complaints and clinical evidence of joint effusion. Knee joints were aspirated by the emergency physician and the synovial fluid tested for lubricating ability and collagen type II degeneration. Lubricating ability was assayed in vitro in an arthrotripsometer oscillating latex apposed to polished glass under a load of 0.35 106 N/m2. Results were reported as the coefficient of friction ( micro ) relative to that of a 0.9% NaCl control; negative deltamicro value indicates lubrication. Comparisons of deltamicro were made to normal SF and aspirates from patients with osteoarthritis (OA) and rheumatoid arthritis. Collagen type II fragments were measured by a novel sandwich ELISA.

RESULTS

Synovial fluid aliquots (n = 57) lubricated poorly with deltamicro = -0.045 (95% confidence interval = -0.006, -0.083) compared to normal SF with D micro = -0.095 (95% CI = -0.088, -0.101). Only 20.6% of knee joint aspirates possessed normal lubricating ability. An association exists between nucleated cell count and deltamicro described by a logarithmic function. Collagen type II fragments were present in aspirates at a concentration of 0.636 microg/ml (95% CI 0.495-0.777 microg/ml), significantly higher than 0.173 microg/ml (95% CI 0.154-0.193 microg/ml) in the OA comparison group.

CONCLUSION

Knee joints with synovitis, commonly encountered in the ED, are frequently nonlubricated bearings and display catabolism of collagen type II. This may play a role in acute cartilage destruction ultimately resulting in posttraumatic OA.

摘要

目的

确定急诊科（ED）中需要进行关节穿刺术的关节积液是否具有正常的润滑能力或存在软骨退变的证据。润滑素是一种黏液糖蛋白，由巨核细胞刺激因子基因（GenBank U70136）表达产生，可为关节表面提供软骨保护作用。滑液（SF）润滑能力的丧失与退行性关节疾病的发病机制有关。

方法

对1999年5月1日至2000年10月1日期间因膝关节X线检查阴性且有临床关节积液证据而就诊的成人和儿童患者进行一项回顾性ED观察性研究。膝关节由急诊医生进行穿刺，并对滑液进行润滑能力和II型胶原退变检测。润滑能力在体外通过在0.35×10⁶ N/m²的负荷下，使关节摩擦测定仪中的乳胶与抛光玻璃振荡接触来测定。结果以相对于0.9%氯化钠对照的摩擦系数（μ）报告；负的Δμ值表示润滑。将Δμ与正常滑液以及骨关节炎（OA）和类风湿关节炎患者的穿刺液进行比较。II型胶原片段通过一种新型夹心ELISA进行测定。

结果

与正常滑液（Δμ = -0.095，95%置信区间 = -0.088，-0.101）相比，滑液等分试样（n = 57）的润滑能力较差，Δμ = -0.045（95%置信区间 = -0.006，-0.083）。只有20.6%的膝关节穿刺液具有正常的润滑能力。有核细胞计数与通过对数函数描述的Δμ之间存在关联。穿刺液中II型胶原片段的浓度为0.636 μg/ml（95%置信区间0.495 - 0.777 μg/ml），显著高于OA比较组中的0.173 μg/ml（95%置信区间0.154 - 0.193 μg/ml）。