血清尿酸水平可预测内侧膝关节骨关节炎非痛风患者的关节间隙变窄。
Serum Urate Levels Predict Joint Space Narrowing in Non-Gout Patients With Medial Knee Osteoarthritis.
机构信息
New York University School of Medicine, New York, New York.
出版信息
Arthritis Rheumatol. 2017 Jun;69(6):1213-1220. doi: 10.1002/art.40069. Epub 2017 Apr 28.
OBJECTIVE
The pathogenesis of osteoarthritis (OA) includes both mechanical and inflammatory features. Studies have implicated synovial fluid uric acid (UA) as a potential OA biomarker, possibly reflecting chondrocyte damage. Whether serum UA levels reflect/contribute to OA is unknown. We investigated whether serum UA levels predict OA progression in a non-gout knee OA population.
METHODS
Eighty-eight patients with medial knee OA (body mass index [BMI] <33 kg/m ) but without gout were studied. Baseline serum UA levels were measured in previously banked serum samples. At 0 and 24 months, patients underwent standardized weight-bearing fixed-flexion posteroanterior knee radiography to determine joint space width (JSW) and Kellgren/Lawrence grades. Joint space narrowing (JSN) was calculated as the change in JSW from 0 to 24 months. Twenty-seven patients underwent baseline contrast-enhanced 3T knee magnetic resonance imaging for assessment of synovial volume.
RESULTS
Serum UA levels correlated with JSN values in both univariate (r = 0.40, P < 0.01) and multivariate (r = 0.28, P = 0.01) analyses. There was a significant difference in mean JSN after dichotomization at a serum UA cut point of 6.8 mg/dl, the solubility point for serum urate, even after adjustment (JSN of 0.90 mm for a serum UA ≥6.8 mg/dl and 0.31 mm for a serum UA <6.8 mg/dl; P < 0.01). Baseline serum UA levels distinguished progressors (JSN >0.2 mm) and fast progressors (JSN >0.5 mm) from nonprogressors (JSN ≤0.0 mm) in multivariate analyses (area under the receiver operating characteristic curve 0.63 [P = 0.03] and 0.62 [P = 0.05], respectively). Serum UA levels correlated with the synovial volume (r = 0.44, P < 0.01), a possible marker of JSN, although this correlation did not persist after controlling for age, sex, and BMI (r = 0.13, P = 0.56).
CONCLUSION
In non-gout patients with knee OA, the serum UA level predicted future JSN and may serve as a biomarker for OA progression.
目的
骨关节炎（OA）的发病机制包括机械和炎症特征。研究表明滑液尿酸（UA）可能是潜在的 OA 生物标志物，可能反映了软骨细胞损伤。血清 UA 水平是否反映/有助于 OA 尚不清楚。我们研究了血清 UA 水平是否可预测非痛风膝 OA 人群中的 OA 进展。
方法
研究了 88 例内侧膝 OA（BMI<33 kg/m ）但无痛风的患者。在先前保存的血清样本中测量了基线血清 UA 水平。在 0 和 24 个月时，患者接受了标准化的负重固定屈膝前后位膝关节射线照相术，以确定关节间隙宽度（JSW）和 Kellgren/Lawrence 分级。通过计算 0 至 24 个月 JSW 的变化来确定关节间隙狭窄（JSN）。27 例患者进行了基线对比增强 3T 膝关节磁共振成像评估滑膜体积。
结果
血清 UA 水平与单变量（r=0.40，P<0.01）和多变量（r=0.28，P=0.01）分析中的 JSN 值相关。在血清 UA 截断点为 6.8 mg/dl（血清尿酸的溶解度点）时，血清 UA 水平的均值差异具有统计学意义，即使在调整后也是如此（血清 UA≥6.8 mg/dl 时 JSN 为 0.90 mm，血清 UA<6.8 mg/dl 时 JSN 为 0.31 mm；P<0.01）。基线血清 UA 水平可区分进展者（JSN>0.2 mm）和快速进展者（JSN>0.5 mm）与非进展者（JSN≤0.0 mm）（多变量分析中曲线下面积分别为 0.63[P=0.03]和 0.62[P=0.05]）。血清 UA 水平与滑膜体积（r=0.44，P<0.01）相关，这可能是 JSN 的标志物，但在控制年龄、性别和 BMI 后，这种相关性不再存在（r=0.13，P=0.56）。
结论
在膝 OA 非痛风患者中，血清 UA 水平预测了未来的 JSN，可能是 OA 进展的生物标志物。
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