Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Rd, Oxford OX3 7LD, UK.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Rd, Oxford OX3 7LD, UK.
Semin Arthritis Rheum. 2014 Feb;43(4):570-6. doi: 10.1016/j.semarthrit.2013.08.006. Epub 2013 Sep 26.
Our primary objective was to summarise the known effects of locally administered glucocorticoid on tendon tissue and tendon cells.
We conducted a systematic review of the scientific literature using the PRISMA and Cochrane guidelines of the Medline database using specific search criteria. The search yielded 50 articles, which consisted of 13 human studies, 36 animal studies and one combined human/animal study.
Histologically, there was a loss of collagen organisation (6 studies) and an increase in collagen necrosis (3 studies). The proliferation (8 studies) and viability (9 studies) of fibroblasts was reduced. Collagen synthesis was decreased in 17 studies. An increased inflammatory cell infiltrate was shown in 4 studies. Increased cellular toxicity was demonstrated by 3 studies. The mechanical properties of tendon were investigated by 18 studies. Descriptively, 6 of these studies showed a decrease in mechanical properties, 3 showed an increase, while the remaining 9 showed no significant change. A meta-analysis of the mechanical data revealed a significant deterioration in mechanical properties, with an overall effect size of -0.67 (95% CI = 0.01 to -1.33) (data from 9 studies).
Overall it is clear that the local administration of glucocorticoid has significant negative effects on tendon cells in vitro, including reduced cell viability, cell proliferation and collagen synthesis. There is increased collagen disorganisation and necrosis as shown by in vivo studies. The mechanical properties of tendon are also significantly reduced. This review supports the emerging clinical evidence that shows significant long-term harms to tendon tissue and cells associated with glucocorticoid injections.
我们的主要目标是总结局部给予糖皮质激素对肌腱组织和肌腱细胞的已知影响。
我们按照 PRISMA 和 Cochrane 指南，使用 Medline 数据库的特定搜索标准对科学文献进行了系统评价。搜索结果得到 50 篇文章，其中包括 13 项人体研究、36 项动物研究和 1 项人体/动物混合研究。
组织学上，胶原组织丧失（6 项研究）和胶原坏死增加（3 项研究）。成纤维细胞的增殖（8 项研究）和活力（9 项研究）降低。17 项研究显示胶原合成减少。4 项研究显示炎症细胞浸润增加。3 项研究表明细胞毒性增加。18 项研究调查了肌腱的机械性能。其中 6 项研究表明机械性能下降，3 项研究表明机械性能增加，而其余 9 项研究表明无显著变化。对机械数据的荟萃分析显示，机械性能显著恶化，总体效应大小为-0.67（95%CI=0.01 至-1.33）（来自 9 项研究的数据）。
总体而言，很明显，局部给予糖皮质激素对体外肌腱细胞有显著的负面影响，包括细胞活力、细胞增殖和胶原合成减少。体内研究显示胶原结构紊乱和坏死增加。肌腱的机械性能也显著降低。这一综述支持了新兴的临床证据，表明与糖皮质激素注射相关的肌腱组织和细胞存在显著的长期损害。
