Kubota E, Imamura H, Kubota T, Shibata T, Murakami K
Second Department of Oral and Maxillofacial Surgery, Kanagawa Dental College, Yokosuka, Japan.
J Oral Maxillofac Surg. 1997 Jan;55(1):20-7; discussion 27-8. doi: 10.1016/s0278-2391(97)90438-9.
This study investigated the early signs of synovitis and cartilage degradation by means of synovial fluid analysis in temporomandibular joints (TMJs) with internal derangement (closed lock) or osteoarthritis (OA).
Synovial fluid was obtained from 25 TMJs in 22 patients diagnosed with closed lock and from 15 asymptomatic TMJs of 12 normal controls. IL-1 beta concentrations were measured using enzyme-linked immunosorbent assay (ELISA), and proteinase activity was detected by means of gelatin enzymography.
Nine of the 25 TMJs with closed lock (CL group) exhibited osteolytic changes on the surface of the condyle. TMJs in the normal control group did not show any bony changes. Mean IL-1 beta concentration in the synovial fluid (SF) protein in the CL group was 330.1 +/- 347.7 pg per 100 micrograms protein, which was significantly higher than in the normal control (76.7 +/- 95.3 pg/100 micrograms SF-protein). Synovial fluid from the TMJs with osteolytic changes contained higher levels of IL-1 beta (531.8 +/- 379.6 pg/100 micrograms SF-protein) than those without bony changes (216.7 +/- 280.1 pg/100 micrograms SF-protein). Matrix metalloproteinase (MMP) activity with a molecular weight of 50 kd (stromelysin or MMP3) was detected in a highly augmented form in two synovial fluid samples of seven closed lock patients.
The results suggest that IL-1 beta levels in synovial fluid of the TMJ have a positive correlation with OA change. The MMP3 activity detected was greatly increased in patients with cartilage degradation. These findings suggest that both changes may be important markers of early bone deterioration in TMJs that are undetectable by radiograph imaging.
本研究通过对患有内紊乱（闭锁）或骨关节炎（OA）的颞下颌关节（TMJ）进行滑液分析，调查滑膜炎和软骨降解的早期迹象。
从22例诊断为闭锁的患者的25个TMJ以及12名正常对照者的15个无症状TMJ中获取滑液。使用酶联免疫吸附测定（ELISA）测量白细胞介素-1β（IL-1β）浓度，并通过明胶酶谱法检测蛋白酶活性。
25个闭锁TMJ（CL组）中有9个在髁突表面表现出溶骨改变。正常对照组的TMJ未显示任何骨质改变。CL组滑液（SF）蛋白中的平均IL-1β浓度为每100微克蛋白330.1±347.7皮克，显著高于正常对照组（76.7±95.3皮克/100微克SF蛋白）。有溶骨改变的TMJ的滑液中IL-1β水平（531.8±379.6皮克/100微克SF蛋白）高于无骨质改变的TMJ（216.7±280.1皮克/100微克SF蛋白）。在7例闭锁患者的两份滑液样本中检测到分子量为50kd的基质金属蛋白酶（MMP）活性（基质溶解素或MMP3）以高度增强的形式存在。
结果表明，TMJ滑液中的IL-1β水平与OA改变呈正相关。检测到的MMP3活性在软骨降解患者中大大增加。这些发现表明，这两种改变可能是TMJ早期骨质恶化的重要标志物，而X线影像学无法检测到。
