Mathieu Pierre, Conrozier Thierry, Vignon Eric, Rozand Yves, Rinaudo Marguerite
Laboratoire d'exploration et de morphométrie articulaire, Centre hospitalier Lyon-Sud, Pierre-Bénite, France.
Clin Orthop Relat Res. 2009 Nov;467(11):3002-9. doi: 10.1007/s11999-009-0867-x. Epub 2009 May 6.
Viscosupplementation is a symptomatic treatment of osteoarthritis (OA) intended to restore rheologic homeostasis of the synovial fluid by injecting hyaluronic acid intraarticularly. Despite the long history of this therapy, little is known about its mechanisms of action and differences between commercial preparations. We investigated the rheologic behavior of OA synovial fluid with time, when stored at 4 degrees C, before and after the addition of two hyaluronic acid commercial preparations (linear and cross-linked). Thirteen OA synovial fluids were stored at 4 degrees C and assayed using steric exclusion chromatography, which allows hyaluronic acid to be separated from the remaining pool of proteins and its molecular weight and concentration to be determined without any pretreatment and calibration. The synovial fluid rheology also was studied in vitro, before and after addition of two viscosupplements, over 6 weeks. The non-Newtonian behavior of synovial fluid throughout followup appears to be the result of loose interactions between proteins and hyaluronic acid. When mixed with the linear hyaluronic acid, synovial fluid becomes less non-Newtonian whereas the non-Newtonian behavior was reinforced when mixed with the cross-linked hyaluronic acid. The rheology was nearly unchanged for all synovial fluids over 6 weeks. Our preliminary trial shows it is possible to study synovial fluid, stored at 4 degrees C, over a long time and suggests the enzymatic degradation of hyaluronic acid is negligible under these experimental conditions.
关节腔内注射透明质酸以恢复滑液的流变学稳态，粘弹性补充疗法是骨关节炎（OA）的一种对症治疗方法。尽管这种疗法历史悠久，但其作用机制以及不同商业制剂之间的差异仍知之甚少。我们研究了在4℃储存时，添加两种市售透明质酸制剂（线性和交联）前后，OA滑液随时间的流变学行为。13份OA滑液样本在4℃储存，并使用空间排阻色谱法进行分析，该方法无需任何预处理和校准即可将透明质酸与其余蛋白质池分离，并测定其分子量和浓度。还在体外研究了添加两种粘弹性补充剂前后滑液在6周内的流变学特性。在整个随访过程中，滑液的非牛顿行为似乎是蛋白质与透明质酸之间松散相互作用的结果。当与线性透明质酸混合时，滑液的非牛顿性降低，而与交联透明质酸混合时，非牛顿行为增强。所有滑液在6周内的流变学几乎没有变化。我们的初步试验表明，在4℃储存的滑液可以进行长时间研究，并且表明在这些实验条件下透明质酸的酶促降解可以忽略不计。
