一项基于人群的无症状研究中体重指数与膝关节软骨损伤的关联
Association of body mass index with knee cartilage damage in an asymptomatic population-based study.
作者信息
Keng Alvin, Sayre Eric C, Guermazi Ali, Nicolaou Savvakis, Esdaile John M, Thorne Anona, Singer Joel, Kopec Jacek A, Cibere Jolanda
机构信息
University of Toronto, Toronto, ON, Canada.
Arthritis Research Centre of Canada, Richmond, BC, Canada.
出版信息
BMC Musculoskelet Disord. 2017 Dec 8;18(1):517. doi: 10.1186/s12891-017-1884-7.
BACKGROUND
Cartilage changes are an important early finding of osteoarthritis (OA), which can exist even before symptoms. Our objective was to determine the prevalence of knee cartilage damage on magnetic resonance imaging (MRI) in an asymptomatic population-based cross-sectional study and to evaluate the association of body mass index (BMI) with cartilage damage.
METHODS
Subjects, aged 40-79 years, without knee pain (n = 73) were recruited as a random population sample and assessed for BMI (kg/m), including current BMI (measured), past BMI at age 25 (self-reported) and change in BMI. Knee cartilage was scored semi-quantitatively (grades 0-4) on MRI. In primary analysis, cartilage damage was defined as ≥2 (at least moderate) and in a secondary analysis as ≥3 (severe). We also conducted a sensitivity analysis by dichotomizing current BMI as <25 vs. ≥25. Logistic regression was used to evaluate the association of each BMI variable with prevalent MRI-detected cartilage damage, adjusted for age and sex.
RESULTS
Of 73 subjects, knee cartilage damage ≥2 and ≥3 was present in 65.4% and 28.7%, respectively. The median current BMI was 26.1, median past BMI 21.6, and median change in BMI was a gain of 2.8. For cartilage damage ≥2, current BMI had a non-statistically significant OR of 1.65 per 5 units (95% CI 0.93-2.92). For cartilage damage ≥3, current BMI showed a trend towards statistical significance with an OR of 1.70 per 5 units (95% CI 0.99-2.92). Past BMI and change in BMI were not significantly associated with cartilage damage. Current BMI ≥ 25 was statistically significantly associated with cartilage damage ≥2 (OR 3.04 (95% CI 1.10-8.42)), but not for ≥3 (OR 2.63 (95% CI 0.86-8.03)).
CONCLUSIONS
MRI-detected knee cartilage damage was highly prevalent in this asymptomatic population-based cohort. We report a trend towards significance of BMI with cartilage damage severity. Subjects with abnormal current BMI (≥25) had a 3-fold increased odds of cartilage damage ≥2, compared to those with normal BMI. This study lends support towards the role of obesity in the pathogenesis of knee cartilage damage at an asymptomatic stage of disease.
背景
软骨变化是骨关节炎（OA）的一项重要早期表现，甚至在症状出现之前就可能存在。我们的目的是在一项基于人群的无症状横断面研究中，确定磁共振成像（MRI）检测到的膝关节软骨损伤的患病率，并评估体重指数（BMI）与软骨损伤之间的关联。
方法
招募年龄在40 - 79岁、无膝关节疼痛的受试者（n = 73）作为随机人群样本，并评估其BMI（kg/m²），包括当前BMI（测量值）、25岁时的既往BMI（自我报告）以及BMI的变化。通过MRI对膝关节软骨进行半定量评分（0 - 4级）。在初步分析中，软骨损伤定义为≥2级（至少为中度），在二次分析中定义为≥3级（重度）。我们还通过将当前BMI分为<25和≥25进行了敏感性分析。采用逻辑回归评估每个BMI变量与MRI检测到的现患软骨损伤之间的关联，并对年龄和性别进行了校正。
结果
在73名受试者中，膝关节软骨损伤≥2级和≥3级的比例分别为65.4%和28.7%。当前BMI的中位数为26.1，既往BMI的中位数为21.6，BMI的中位数变化为增加2.8。对于软骨损伤≥2级，当前BMI每增加5个单位，其比值比（OR）为1.65，差异无统计学意义（95%置信区间[CI] 0.93 - 2.92）。对于软骨损伤≥3级，当前BMI显示出具有统计学意义的趋势，每增加5个单位的OR为1.70（CI 0.99 - 2.92）。既往BMI和BMI变化与软骨损伤无显著关联。当前BMI≥25与软骨损伤≥2级具有统计学显著关联（OR 3.04，95% CI 1.10 - 8.42），但与≥3级无关（OR 2.63，CI 0.86 - 8.03）。
结论
在这个基于人群的无症状队列中，MRI检测到的膝关节软骨损伤非常普遍。我们报告了BMI与软骨损伤严重程度之间存在显著趋势。与BMI正常的受试者相比，当前BMI异常（≥25）的受试者软骨损伤≥2级的几率增加了3倍。这项研究支持了肥胖在疾病无症状阶段膝关节软骨损伤发病机制中的作用。
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