Hart D J, Doyle D V, Spector T D
Department of Rheumatology, St. Thomas Cross Hospital, London, UK.
J Rheumatol. 1995 Jun;22(6):1118-23.
Several studies have shown an association with density and knee osteoarthritis (OA), however the role of other metabolic factors is unclear, with conflicting data in the literature. We studied the association between metabolic risk factors and k nee OA in women in the general population.
One thousand three women aged 45-64 from the Chingford population study completed risk factor questionnaires. Current blood pressure and ever hypertension were noted and fasting blood glucose, serum cholesterol, triglycerides, high density lipoprotein( HDL), and uric acid levels were measured. AP weight bearing radiographs were available in 979 women and scored using the Kellgren and Lawrence system. Grade 2+ (definite osteophytes) was used a definition of knee OA. Odds ratios (OR) and 95% confidence intervals were calculated for risk of knee OA in highest tertile versus lowest for death risk factor. All OR were adjusted for age and body mass index as potential confounders for OA.
Radiological evidence of knee OA was found in 118 women (12%). For knee OA in either knee the variables significantly associated were raised blood glucose OR = 1.95 (1.08-3.59), and moderately raised serum cholesterol OR = 2.06 (1.06-3.98). For symptomatic women (n = 58) raised blood glucose OR = 2.77 (1.13-6.76), and use of diuretics OR = 2.27 (1.11-4.65) were significantly associated. For bilateral knee disease (n = 55) significant associations were found for ever hypertension OR = 3.02 (1.51-6.06), subjects taking diuretics OR = 2.84 (1.37-5.89), and both high and moderately raised serum cholesterol OR = 3.91 (1.07-14.25), and OR = 3.63 (1.00-13.88), respectively. In all categories of knee OA serum uric acid was nonsignificantly increased. No association was found with raised triglyceride or HDL levels or with current systolic blood pressure. Further adjustment for physical activity and social class did not affect the results.
These data suggest that hypertension, hypercholesterolemia, and blood glucose are associated with both unilateral and bilateral knee OA independent of obesity, and support the concept that OA has an important systemic and metabolic component in its etiology.
多项研究表明骨密度与膝关节骨关节炎（OA）之间存在关联，然而其他代谢因素的作用尚不清楚，文献中的数据相互矛盾。我们研究了一般人群中女性代谢危险因素与膝关节OA之间的关联。
来自Chingford人群研究的1300名45 - 64岁女性完成了危险因素问卷。记录当前血压和既往高血压情况，并测量空腹血糖、血清胆固醇、甘油三酯、高密度脂蛋白（HDL）和尿酸水平。979名女性有负重位X线片，并使用Kellgren和Lawrence系统进行评分。2级及以上（明确的骨赘）被用作膝关节OA的定义。计算最高三分位数与最低三分位数的死亡危险因素中膝关节OA风险的比值比（OR）和95%置信区间。所有OR均针对年龄和体重指数进行调整，作为OA的潜在混杂因素。
118名女性（12%）有膝关节OA的影像学证据。对于任一侧膝关节的OA，显著相关的变量为血糖升高，OR = 1.95（1.08 - 3.59），以及血清胆固醇中度升高，OR = 2.06（1.06 - 3.98）。对于有症状的女性（n = 58），血糖升高，OR = 2.77（1.13 - 6.76），以及使用利尿剂，OR = 2.27（1.11 - 4.65）显著相关。对于双侧膝关节疾病（n = 55），发现显著关联的因素为既往高血压，OR = 3.02（1.51 - 6.06），服用利尿剂的受试者，OR = 2.84（1.37 - 5.89），以及血清胆固醇高度和中度升高，OR分别为3.91（1.07 - 14.25）和3.63（1.00 - 13.88）。在所有膝关节OA类别中，血清尿酸无显著升高。未发现与甘油三酯升高、HDL水平或当前收缩压有关联。进一步对体力活动和社会阶层进行调整并未影响结果。
这些数据表明高血压、高胆固醇血症和血糖与单侧和双侧膝关节OA均相关，独立于肥胖，支持OA在其病因中具有重要的全身和代谢成分这一概念。
