Ghroubi S, Elleuch H, Guermazi M, Kaffel N, Feki H, Abid M, Baklouti S, Elleuch M H
Service de médecine physique, rééducation fonctionnelle et réadaptation fonctionnelle, CHU Habib-Bourguiba, université du sud, Sfax, Tunisie.
Ann Readapt Med Phys. 2007 Nov;50(8):661-6. doi: 10.1016/j.annrmp.2007.03.005. Epub 2007 Mar 28.
The objective of our study was to determine whether waist circumference (WC) is a more reliable indicator than body mass index (BMI) of the presence of knee osteoarthritis in obese subjects.
We performed an observational study of obese patients with no other risk factors for knee osteoarthritis. For each patient, we evaluated BMI, WC, duration of obesity and knee pain. Two groups were identified: "asymptomatic patients" (AG), without knee pain, and "symptomatic patients" (SG). For the SG, we measured pain intensity (visual analog scale [VAS], 0-100 mm) and functional repercussions (using the Lequesne and WOMAC indexes). Patients with knee pain underwent standard radiographic procedures to search for signs of osteoarthritis, and the SG was divided into two subgroups: with radiological signs of osteoarthritis (SG-1) and without radiological signs of osteoarthritis (SG-2). The AG and SG groups and SG-1 and SG-2 groups were compared for age, sex, and duration of obesity. Comparisons of BMI, WC, and function involved the Student's t-test.
We recruited 56 patients for the study (82.5% females; mean obesity duration (13+/-6.5 years; mean age 43.21+/-9.58 years). The mean BMI was 39.6+/-7.23 kg/m(2) and mean WC was 113+/-14.3 cm. We found 33 patients (59%) with knee pain. Independent of age, sex, duration of obesity and BMI, the SG showed more significant WC (117.27+/-14.71 cm vs. 107+/-11.75 cm for the AG, P 0.01). In the same group and independent of the already mentioned factors, the patients with radiological signs of osteoarthritis showed significant WC [122+/-15.57 cm (SG-1) vs. 108+/-6.88 cm (SG-2) (P 0.01)]. Moreover, the VAS score of pain at rest and during effort and the WOMAC and Lequesne scores were 16+/-25.7 mm, 75+/-18.3 mm, 12.3+/-8.92 and 11.5+/-5.44 (SG-1) and 7+/-18.4 mm, 70+/-19.2 mm, 5.7+/-3.05, and 6.9+/-3.79 (SG-2), respectively. The difference between SG-1 and SG-2 was significant only for the WOMAC (P=0.015) and Lequesne (P=0.026) scores.
Independent of BMI, WC appears to be a factor associated with the presence of knee pain and osteoarthritis in obese patients. Furthermore, a high WC is associated with significant functional repercussion.
我们研究的目的是确定在肥胖受试者中，腰围（WC）是否比体重指数（BMI）更能可靠地指示膝关节骨关节炎的存在。
我们对无其他膝关节骨关节炎危险因素的肥胖患者进行了一项观察性研究。对每位患者，我们评估了BMI、WC、肥胖持续时间和膝关节疼痛情况。确定了两组：“无症状患者”（AG组），无膝关节疼痛；“有症状患者”（SG组）。对于SG组，我们测量了疼痛强度（视觉模拟评分法[VAS]，0 - 100毫米）和功能影响（使用Lequesne和WOMAC指数）。有膝关节疼痛的患者接受标准的放射学检查以寻找骨关节炎的迹象，SG组又分为两个亚组：有骨关节炎放射学迹象的（SG - 1）和无骨关节炎放射学迹象的（SG - 2）。比较了AG组和SG组以及SG - 1组和SG - 2组的年龄、性别和肥胖持续时间。BMI、WC和功能的比较采用学生t检验。
我们招募了56名患者进行研究（82.5%为女性；平均肥胖持续时间为（13±6.5年；平均年龄43.21±9.58岁）。平均BMI为39.6±7.23千克/米²，平均WC为113±14.3厘米。我们发现33名患者（59%）有膝关节疼痛。独立于年龄、性别、肥胖持续时间和BMI，SG组的WC更显著（AG组为107±11.75厘米，SG组为117.27±14.71厘米，P < 0.01）。在同一组中且独立于上述已提及的因素，有骨关节炎放射学迹象的患者WC显著[SG - 1组为122±15.57厘米，SG - 2组为108±6.88厘米（P < 0.01）]。此外，静息和用力时的VAS疼痛评分以及WOMAC和Lequesne评分在SG - 1组分别为16±25.7毫米、75±18.3毫米、12.3±8.92和11.5±5.44，在SG - 2组分别为7±18.4毫米、70±19.2毫米、5.7±3.05和6.9±3.79。SG - 1组和SG - 2组之间的差异仅在WOMAC（P = 0.015）和Lequesne（P = 0.026）评分上显著。
独立于BMI，WC似乎是肥胖患者膝关节疼痛和骨关节炎存在的相关因素。此外，高WC与显著的功能影响相关。
