Université Paris 7, UFR médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris Cedex, France.
Ann Rheum Dis. 2011 Jan;70(1):139-44. doi: 10.1136/ard.2010.134015. Epub 2010 Oct 26.
To investigate the effect of massive weight loss on (1) knee pain and disability, (2) low-grade inflammation and metabolic status and (3) joint biomarkers in obese patients with knee osteoarthritis (OA).
140 patients involved in a gastric surgery programme were screened for painful knee OA, and 44 were included (age 44 ± 10.3 years, body mass index (BMI) 50.7 ± 7.2 kg/m(2)). Clinical data and biological samples were collected before and 6 months after surgery.
Before surgery, interleukin 6 (IL-6) levels were correlated with levels of high-sensitivity C reactive protein (hsCRP) (p=0.006) and Helix-II (p=0.01), a biomarker of cartilage turnover, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (p=0.03). Surgery resulted in substantial decrease in BMI (-20%). Levels of insulin and insulin resistance were decreased at 6 months. Knee pain decreased after surgery (24.5 ± 21 mm vs 50 ± 26.6 mm; p<0.001), and scores on all WOMAC subscales were improved. Levels of IL-6 (p<0.0001), hsCRP (p<0.0001), orosomucoid (p<0.0001) and fibrinogen (p=0.04) were decreased after surgery. Weight loss resulted in a significant increase in N-terminal propeptide of type IIA collagen levels (+32%; p=0.002), a biomarker of cartilage synthesis, and a significant decrease in cartilage oligomeric matrix protein (COMP) (-36%; p<0.001), a biomarker of cartilage degradation. Changes in COMP concentration were correlated with changes in insulin levels (p=0.02) and insulin resistance (p=0.05).
Massive weight loss improves pain and function and decreases low-grade inflammation. Change in levels of joint biomarkers with weight loss suggests a structural effect on cartilage.
研究体重大量减轻对肥胖膝骨关节炎（OA）患者（1）膝关节疼痛和功能障碍，（2）低度炎症和代谢状态，以及（3）关节生物标志物的影响。
对参加胃手术项目的 140 名患者进行了膝关节疼痛性 OA 的筛查，其中 44 名患者纳入研究（年龄 44 ± 10.3 岁，体重指数（BMI）50.7 ± 7.2 kg/m(2)）。手术前和手术后 6 个月收集临床数据和生物样本。
手术前，白细胞介素 6（IL-6）水平与高敏 C 反应蛋白（hsCRP）（p=0.006）和软骨周转率标志物螺旋-II（p=0.01）和 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）功能评分（p=0.03）相关。手术后 BMI 显著下降（-20%）。6 个月时胰岛素和胰岛素抵抗水平下降。膝关节疼痛减轻（24.5 ± 21 毫米对 50 ± 26.6 毫米；p<0.001），WOMAC 各亚量表评分均有改善。手术后 IL-6（p<0.0001）、hsCRP（p<0.0001）、粘蛋白（orosomucoid）（p<0.0001）和纤维蛋白原（p=0.04）水平下降。体重减轻导致 IIA 型胶原前肽水平显著升高（+32%；p=0.002），这是软骨合成的生物标志物，软骨寡聚基质蛋白（COMP）显著降低（-36%；p<0.001），这是软骨降解的生物标志物。COMP 浓度的变化与胰岛素水平（p=0.02）和胰岛素抵抗（p=0.05）的变化相关。
体重大量减轻可改善疼痛和功能，减轻低度炎症。体重减轻引起的关节生物标志物水平变化提示对软骨有结构作用。
