关节滑液和尿液 C2C-HUSA 水平与全膝关节置换术后手术结果的相关性。
Association of synovial fluid and urinary C2C-HUSA levels with surgical outcomes post-total knee arthroplasty.
机构信息
Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Division of Orthopaedics, Osteoarthritis Research Program, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Dalla Lana School of Public Health and Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada.
出版信息
Osteoarthritis Cartilage. 2024 Jan;32(1):98-107. doi: 10.1016/j.joca.2023.09.009. Epub 2023 Oct 5.
OBJECTIVES
After total knee arthroplasty (TKA), ∼30% of knee osteoarthritis (KOA) patients show little symptomatic improvement. Earlier studies have correlated urinary (u) type 2 collagen C terminal cleavage peptide assay (C2C-HUSA), which detects a fragment of cartilage collagen breakdown, with KOA progression. This study determines whether C2C levels in urine, synovial fluid, or their ratio, are associated with post-surgical outcomes.
METHODS
From a large sample of 489 subjects, diagnosed with primary KOA undergoing TKA, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores were collected at baseline (time of surgery) and one-year post-TKA. Baseline urine (u) and synovial fluid (sf) were analysed using the IBEX-C2C-HUSA assay, with higher values indicating higher amounts of cartilage degradation. For urine, results were normalised to creatinine. Furthermore, subjects' changes in WOMAC scores were categorised based on percent reduction in pain or improvement in function, compared to baseline, such that >66.7%, >33.3 to ≤66.7%, and ≤33.3% denoted "strong", "moderate" and "mild/worse" responses, respectively. Associations of individual biofluid C2C-HUSA levels, or their ratio, with change in WOMAC pain and function scores up to one-year post-TKA, or category of change, were analysed by linear, logistic, or cumulative odds models.
RESULTS
Higher baseline uC2C-HUSA levels or a lower ratio of baseline sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC pain by linear multivariable modelling [odds ratio -0.40 (95% confidence interval -0.76, -0.05) p = 0.03; 0.36 (0.01, 0.71), p = 0.04, respectively], while sfC2C-HUSA alone was not. However, lower ratios of sfC2C-HUSA to uC2C-HUSA were associated with improvements in WOMAC function [1.37 (0.18, 2.55), p = 0.02], while sfC2C-HUSA and uC2C-HUSA alone were not. Lower ratios of sfC2C-HUSA to uC2C-HUSA were also associated with an increased likelihood of a subject being categorised in a group where TKA was beneficial in both univariable [pain, 0.81 (0.68, 0.96), p = 0.02; function, 0.92 (0.85, 0.99), p = 0.035] and multivariable [pain, 0.81 (0.68, 0.97) p = 0.02; function, 0.92 (0.85, 1.00), p = 0.043] ordinal modelling, while sfC2C-HUSA and uC2C-HUSA alone were not.
CONCLUSIONS
Overall, ratios of baseline sfC2C-HUSA to uC2C-HUSA, and baseline uC2C-HUSA, may play an important role in studying post-TKA surgical outcomes.
目的
全膝关节置换术（TKA）后，约 30%的膝关节骨关节炎（KOA）患者症状改善不明显。早期研究已经将尿（u）2 型胶原 C 端裂解肽检测（C2C-HUSA）与 KOA 进展相关联，该检测可检测到软骨胶原分解的片段。本研究旨在确定尿、滑液中 C2C 水平或其比值是否与术后结果相关。
方法
从一个 489 名患有原发性 KOA 并接受 TKA 的大样本中，在基线（手术时）和 TKA 后一年收集 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）疼痛和功能评分。使用 IBEX-C2C-HUSA 测定法分析基线时的尿（u）和滑液（sf），较高的值表明更高程度的软骨降解。对于尿，结果根据与基线相比疼痛减少的百分比或功能改善，用肌酐进行标准化。此外，根据与基线相比疼痛减少或功能改善的百分比，将受试者 WOMAC 评分的变化分为“强”、“中”和“弱/差”反应，分别为>66.7%、>33.3%至≤66.7%和≤33.3%。采用线性、逻辑或累积优势模型分析基线时单个生物流体 C2C-HUSA 水平或其比值与 TKA 后一年 WOMAC 疼痛和功能评分变化或变化类别之间的关系。
结果
基线 uC2C-HUSA 水平较高或基线 sfC2C-HUSA 与 uC2C-HUSA 的比值较低与 WOMAC 疼痛的线性多变量模型改善相关[比值比-0.40（95%置信区间-0.76，-0.05）p=0.03；0.36（0.01，0.71），p=0.04]，而 sfC2C-HUSA 本身则不然。然而，较低的 sfC2C-HUSA 与 uC2C-HUSA 的比值与 WOMAC 功能的改善相关[1.37（0.18，2.55），p=0.02]，而 sfC2C-HUSA 和 uC2C-HUSA 本身则不然。较低的 sfC2C-HUSA 与 uC2C-HUSA 的比值也与受试者被归类为 TKA 在单变量[疼痛，0.81（0.68，0.96），p=0.02；功能，0.92（0.85，0.99），p=0.035]和多变量[疼痛，0.81（0.68，0.97）p=0.02；功能，0.92（0.85，1.00），p=0.043]有序模型中获益的可能性增加相关，而 sfC2C-HUSA 和 uC2C-HUSA 本身则不然。
结论
总的来说，基线 sfC2C-HUSA 与 uC2C-HUSA 的比值和基线 uC2C-HUSA 可能在研究 TKA 术后手术结果方面发挥重要作用。
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