基于 Heberden 结节的存在评估他汀类药物的使用与膝骨关节炎转归：来自骨关节炎倡议研究的结果。
Statin Use and Knee Osteoarthritis Outcome Measures according to the Presence of Heberden Nodes: Results from the Osteoarthritis Initiative.
机构信息
From the Department of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science (A.H., S.D.), and Department of Orthopedic Surgery (X.C.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran (B.M.); Department of Radiology, Boston University School of Medicine, Boston, Mass (A.G., F.W.R.); Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England (P.G.C.); NIHR Leeds Biomedical Research Centre, Leeds, England (P.G.C.); Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, Baltimore, Md (J.A.C.L.); Ciccarone Center for the Prevention of Heart Disease (M.J.B.) and Department of Rheumatology (C.O.B.), Johns Hopkins University, Baltimore, Md; and Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.R.).
出版信息
Radiology. 2019 Nov;293(2):396-404. doi: 10.1148/radiol.2019190557. Epub 2019 Sep 10.
Background The exact contribution of statins to knee osteoarthritis (OA) radiographic outcomes and the characteristics of patients with OA as potential responders to statins remain unclear. Purpose To evaluate the effect of statin use on the incidence of radiographic knee OA (development of Kellgren-Lawrence grade ≥2) and progression of joint space narrowing (JSN) according to the nodal OA status defined according to the presence of Heberden nodes (HNs). Materials and Methods Institutional review boards approved this HIPAA-compliant protocol, and all participants gave informed consent. The Osteoarthritis Initiative (OAI) cohort, which began in 2004 and is ongoing ( identifier, NCT00080171), was used to conduct a longitudinal 1:1 propensity score-matched retrospective analysis of prospectively collected data. Participants were classified as having HN-positive or HN-negative findings according to the presence of HNs at baseline physical examination. In each cohort, per-protocol and new-user design were used to match statin initiators (participants who reported ≤1 year of statin use before enrollment) and nonusers (participants who reported no statin use before enrollment) for variables that potentially contributed to confounding by indication bias. Participants were followed up annually over 8 years. Any associations between statin use and longitudinal knee OA radiographic incidence, JSN progression, or nonacceptable symptomatic state incidence was assessed by using hazard ratios (HRs) of Cox regression. Results In the longitudinal analysis, there were 832 knees of 602 participants (pair-matched knees of statin initiators and nonusers) in the HN-positive cohort (mean age, 64.7 years ± 8.0 [standard deviation]; 377 patients were female [62.6%]) and 386 knees of 285 participants in the HN-negative cohort (mean age, 58.9 years ± 8.2; 144 patients were female [50.5%]). In the HN-positive cohort, statin users had 46% lower risk of JSN progression in comparison with matched nonusers (HR, 0.54; 95% confidence interval [CI]: 0.36, 0.93; = .02). In contrast, in the HN-negative cohort, statin use had no association with radiographic JSN progression (HR, 1.37; [95% CI: 0.74, 2.53]; = .32). Conclusion Statin use was associated with reduced risk of radiographic knee osteoarthritis joint space narrowing progression in patients with nodal osteoarthritis. © RSNA, 2019
背景 他汀类药物在膝关节骨关节炎（OA）放射学结果中的确切作用以及OA 患者作为他汀类药物潜在反应者的特征尚不清楚。目的 根据存在赫伯登结节（HN）定义的节点 OA 状态，评估他汀类药物使用对放射学膝关节 OA（发展为 Kellgren-Lawrence 分级≥2）和关节间隙狭窄（JSN）进展的影响。材料与方法 机构审查委员会批准了本符合 HIPAA 规定的方案，所有参与者均签署了知情同意书。从 2004 年开始并正在进行的骨关节炎倡议（OAI）队列（标识符，NCT00080171）用于对前瞻性收集的数据进行纵向 1:1 倾向评分匹配回顾性分析。根据基线体检时 HN 的存在，将参与者分为 HN 阳性或 HN 阴性。在每个队列中，使用方案和新用户设计来匹配他汀类药物使用者（报告在入组前≤1 年使用他汀类药物的参与者）和非使用者（报告在入组前未使用他汀类药物的参与者），以匹配潜在混杂指示偏倚的变量。参与者在 8 年内每年接受一次随访。使用 Cox 回归的风险比（HR）评估他汀类药物使用与膝关节 OA 放射学发病率、JSN 进展或不可接受的症状状态发生率之间的任何关联。结果 在纵向分析中，HN 阳性队列中有 602 名参与者的 832 个膝关节（他汀类药物使用者和非使用者的配对膝关节）（平均年龄 64.7 岁±8.0[标准差]；377 名女性[62.6%]）和 HN 阴性队列中有 285 名参与者的 386 个膝关节（平均年龄 58.9 岁±8.2；144 名女性[50.5%]）。在 HN 阳性队列中，与匹配的非使用者相比，他汀类药物使用者的 JSN 进展风险降低 46%（HR，0.54；95%置信区间[CI]：0.36，0.93；P =.02）。相比之下，在 HN 阴性队列中，他汀类药物使用与放射学 JSN 进展无关（HR，1.37；95%CI：0.74，2.53；P =.32）。结论 在存在节点 OA 的患者中，他汀类药物的使用与放射学膝关节 OA 关节间隙狭窄进展的风险降低有关。
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