【骨关节炎】滑液中白细胞与滑膜炎程度和治疗效果相关！

浙江大学医学院附属第二医院骨科沈炜亮

骨关节炎是一种具有非常重要炎症色彩的疾病。本研究旨在评估滑液白细胞数目与关节腔注射激素后疾病严重程度和膝关节疼痛减轻之间的关系。

本研究招募了疼痛的膝骨关节炎患者参与本项开放标签的关节腔内注射激素治疗的研究。采用KOOS调查问卷记录膝关节疼痛情况，部分患者进行核磁影像检查。在关节腔注射80mg甲基强的松龙醋酸盐之前，先抽吸关节腔内的滑液用于评估滑液内白细胞数目。

总共55例患者有滑液内白细胞数目方面的资料可用于分析研究。滑液白细胞数目的增加程度与滑膜组织体积增加和核磁下其他疾病严重程度指标升高有关。此外，不同的滑液白细胞增加程度人群，在接受关节注射激素治疗后，分别存在不同程度的KOOS评分的下降。

尽管所有参与试验的患者滑液白细胞数目均在正常范围以内，但总滑液白细胞数目似乎可以作为核磁上评估滑膜炎症的一个生物学标志物，同时也许可以预测抗炎治疗的反应。

AbstractOBJECTIVE: Osteoarthritis (OA) is a disease with a significantinflammatory component. The aim of this analysis was to determine therelationship between synovial fluid (SF) white blood cell (WBC) count and 2parameters: disease severity and the reduction in knee pain afterintraarticular (IA) steroid injection.METHODS: Subjects with painful knee OA were recruited for participationin an open-label study of IA steroid therapy. Information was obtained aboutknee pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS)questionnaire, and a proportion of subjects underwent magnetic resonanceimaging (MRI). Prior to injection with 80 mg methylprednisolone acetate, theindex knee joint was aspirated and the fluid obtained was forwarded forassessment of SF WBC count. RESULTS: Informationon SF WBC count was available for 55 subjects. An increase in WBC countcategory (≤100, 101-250, and 251-1,000 cells/mm3 ) was associatedwith an increase in synovial tissue volume (P=0.028) and with other MRI-based measures of disease severity. Also, witheach increase in SF WBC count category, there was a greater reduction in KOOSscore after steroid injection (for WBC count of ≤100 cells/mm3[referent], mean±SD12.5±15.2; for WBC count of 101-250 cells/mm3 ,mean±SD 21.3±20.6[β coefficient 0.279, P=0.049];for WBC count of 251-1,000 cells/mm3 , mean±SD 29.3±15.2[β coefficient 0.320, P=0.024]). CONCLUSION: Although all participantsin the analysis had SF WBC counts within the "normal" range, total SFWBC count appears to be a biomarker for synovitis on MRI and may also predictresponse to antiinflammatory treatment.

McCabePS, ParkesMJ, MaricarN, HutchinsonCE, FreemontA, O'NeillTW, FelsonDT.Brief Report: Synovial FluidWhite Blood Cell Count in Knee Osteoarthritis: Association With StructuralFindings and Treatment Response.ArthritisRheumatol.2017 Jan;69(1):103-107. doi: 10.1002/art.39829.

整理者/作者：沈炜亮

浙江大学医学院附属第二医院·骨科；

浙江大学骨科研究所；

浙江大学李达三·叶耀珍再生医学发展基金；

浙江省组织工程与再生医学技术重点实验室；

中国医师协会骨科医师分会再生医学工作组；

本人专业诊治范围：

1，肌腱病&肌腱/韧带损伤：肘-网球肘；肩-肩周炎，肩袖损伤；膝-弹跳膝，跑步者膝，前交叉韧带损伤；踝-跟腱炎，跟腱断裂；手腕部-腱鞘炎；筋膜炎

2，再生医学技术治疗运动系统疑难杂症，包括：软骨/半月板/肌腱/韧带的修复、重建和再生；

门诊类型：肌腱病专科门诊！

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致谢：

作者：McCabePS,et al.

翻译：李常虹