Department of Rheumatology, Lyon Sud University Hospital, Pierre Bénite, France.
Clin Exp Rheumatol. 2012 Sep-Oct;30(5):729-34. Epub 2012 Oct 17.
To study the influence of the inflammatory status (flare or not) on hyaluronic acid (HA) and protein composition and on the intrinsic viscosity of the synoviol fluid (SF) from patients with knee osteoarthritis (KOA).
Patients with KOA were classified as having flare (F+) when they fulfilled the 4 following clinical criteria: 1) sudden aggravation of knee pain, 2) whose beginning was identifiable, 3) causing nocturnal awakenings 4) with clinical evidence of knee effusion. Patients were classified F- (no flare) if they do not fulfill any of the 3 first criteria. Forty-four SF were obtained by arthrocentesis and assayed using steric exclusion chromatography, which allows HA to be separated from the proteins and to determine both molecular weight (Mw) and concentration (C) of both HA and proteins. SF rheology was determined using a rheometer at 25°C using a cone and plate geometry. Steady-state viscosity was determined in Pa.s, as a function of the shear rate at 1s-1. Correlations between ( Pa.s) and HA and Pr (Mw, C and Mw x C) were calculated.
Among the 44 assayed SF, 25 were classified F- and 19 F+. There were statistically significant differences between F- and F+ for most of the studied variables: HA concentration and Mw (p=0.01 and 0.001 respectively), protein concentration and Mw (p=0.02 and 0.001 respectively), product Mw x C of the proteins (p<0.0001) and viscosity ή (p=0.0005). The product [(Mw xC) HA x (MwxC) proteins] was highly discriminating between F+ and F- (p<0.0001). The steady state viscosity was highly related to HA concentration (p= 0.0002) and HA Mw (p=0.01) and was negatively correlated with (Mw x C) proteins (p=0.0005), protein concentration (p=0.0007) and protein Mw (p=0.03).
This pilot study shows significant differences of SF composition in patients having a flare-up compared to that of patients who do not have flare. These differences relate to both protein and HA composition and suggest that SF analysis makes possible to distinguish patients with and without flare-up.
研究炎症状态（发作或不发作）对膝关节骨关节炎（KOA）患者滑液中透明质酸（HA）和蛋白质组成以及固有粘度的影响。
将 KOA 患者分为发作组（F+）和非发作组（F-）。发作组患者符合以下 4 项临床标准：1）膝关节疼痛突然加重；2）可明确疼痛起始时间；3）导致夜间觉醒；4）关节腔有渗出的临床证据。如果患者不符合前 3 项标准中的任何一项，则将其分类为非发作组（F-）。通过关节穿刺术获得 44 份滑液，并使用排阻色谱法进行分析，该方法可以将 HA 与蛋白质分离，并同时确定 HA 和蛋白质的分子量（Mw）和浓度（C）。使用锥板流变仪在 25°C 下测定 SF 的流变学特性。在 1s-1的剪切速率下，以 Pa.s 为单位确定稳态粘度。计算（Pa.s）与 HA 和 Pr（Mw、C 和 MwxC）之间的相关性。
在所检测的 44 份滑液中，25 份为 F-，19 份为 F+。F-和 F+组在大多数研究变量上存在统计学差异：HA 浓度和 Mw（p=0.01 和 0.001）、蛋白质浓度和 Mw（p=0.02 和 0.001）、蛋白质的 MwxC 产物（p<0.0001）和粘度 ή（p=0.0005）。（MwxC）HAx（MwxC）蛋白质的乘积在 F+和 F-之间具有高度的区分能力（p<0.0001）。稳态粘度与 HA 浓度（p=0.0002）和 HA Mw（p=0.01）高度相关，与（MwxC）蛋白质（p=0.0005）、蛋白质浓度（p=0.0007）和蛋白质 Mw（p=0.03）呈负相关。
本初步研究表明，在发作患者的滑液成分与不发作患者的滑液成分之间存在显著差异。这些差异与蛋白质和 HA 的组成有关，表明 SF 分析可以区分发作患者和不发作患者。
