肥胖人群的体重减轻对内侧膝关节软骨有结构修饰作用，但对外侧膝关节软骨没有。
Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage.
机构信息
Institute of Bone and Joint Research, Kolling Institute, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
出版信息
Ann Rheum Dis. 2012 Jan;71(1):26-32. doi: 10.1136/ard.2010.144725.
BACKGROUND
Obesity is an important risk factor for knee osteoarthritis (OA), Weight loss can reduce the symptoms of knee OA. No prospective studies assessing the impact of weight loss on knee cartilage structure and composition have been performed.
OBJECTIVES
To assess the impact of weight loss on knee cartilage thickness and composition.
METHODS
111 obese adults were recruited from either laparoscopic adjustable gastric banding or exercise and diet weight loss programmes from two tertiary centres. MRI was performed at baseline and 12-month follow-up to assess cartilage thickness. 78 eligible subjects also underwent delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), an estimate of proteoglycan content. The associations between cartilage outcomes (cartilage thickness and dGEMRIC index) and weight loss were adjusted for age, gender, body mass index (BMI) and presence of clinical knee OA.
RESULTS
Mean age was 51.7 ± 11.8 years and mean BMI was 36.6 ± 5.8 kg/m(2); 32% had clinical knee OA. Mean weight loss was 9.3 ± 11.9%. Percentage weight loss was negatively associated with cartilage thickness loss in the medial femoral compartment in multiple regression analysis (β=0.006, r(2)=0.19, p=0.029). This association was not detected in the lateral compartment (r(2)=0.12, p=0.745). Percentage weight loss was associated with an increase in medial dGEMRIC in multiple regression analysis (β=3.9, r(2)=0.26; p=0.008) but not the lateral compartment (r(2)=0.14, p=0.34). For every 10% weight loss there was a gain in the medial dGEMRIC index of 39 ms (r(2)=0.28; p=0.014). The lowest weight loss cut-off associated with reduced medial femoral cartilage thickness loss and improved medial dGEMRIC index was 7%.
CONCLUSIONS
Weight loss is associated with improvements in the quality (increased proteoglycan content) and quantity (reduced cartilage thickness losses) of medial articular cartilage. This was not observed in the lateral compartment. This could ultimately lead to a reduced need for total joint replacements and is thus a finding with important public health implications.
背景
肥胖是膝关节骨关节炎（OA）的一个重要危险因素，减肥可以减轻膝关节 OA 的症状。目前还没有前瞻性研究评估减肥对膝关节软骨结构和成分的影响。
目的
评估减肥对膝关节软骨厚度和成分的影响。
方法
从两个三级中心的腹腔镜可调节胃束带或运动和饮食减肥计划中招募了 111 名肥胖成年人。在基线和 12 个月的随访中进行 MRI 评估软骨厚度。78 名符合条件的受试者还接受了延迟钆增强 MRI 软骨成像（dGEMRIC）检查，以评估软骨中蛋白聚糖的含量。在调整了年龄、性别、体重指数（BMI）和是否存在临床膝关节 OA 后，评估了软骨结局（软骨厚度和 dGEMRIC 指数）与体重减轻之间的相关性。
结果
平均年龄为 51.7 ± 11.8 岁，平均 BMI 为 36.6 ± 5.8kg/m²；32%有临床膝关节 OA。平均体重减轻 9.3 ± 11.9%。多元回归分析显示，体重减轻百分比与内侧股骨间室的软骨厚度丢失呈负相关（β=0.006，r²=0.19，p=0.029）。在外侧间室中未发现这种相关性（r²=0.12，p=0.745）。多元回归分析显示，体重减轻百分比与内侧 dGEMRIC 的增加呈正相关（β=3.9，r²=0.26；p=0.008），但与外侧间室无关（r²=0.14，p=0.34）。体重减轻每 10%，内侧 dGEMRIC 指数增加 39ms（r²=0.28；p=0.014）。与内侧股骨软骨厚度丢失减少和内侧 dGEMRIC 指数改善相关的最低体重减轻切点为 7%。
结论
减肥与内侧关节软骨质量（增加蛋白聚糖含量）和数量（减少软骨厚度丢失）的改善有关。在外侧间室中未观察到这种情况。这最终可能会减少对全膝关节置换的需求，因此这是一个具有重要公共卫生意义的发现。
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