Alterations in Synovial Fluid Biomarker Levels in Knees With Meniscal Injury as Compared With Asymptomatic Contralateral Knees
Alterations in Synovial Fluid Biomarker Levels in Knees With Meniscal Injury as Compared With Asymptomatic Contralateral Knees
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DOI：
10.1177/0363546519825498
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发表时间：
2019-03-01
影响因子：
4.8
通讯作者：
Strauss, Eric J.
中科院分区：
文献类型：
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作者：
Clair, Andrew J.;Kingery, Matthew T.;Strauss, Eric J.
背景：膝关节关节表面损伤后关节微环境的变化与骨关节炎的发病机制有关。虽然之前的研究主要关注前交叉韧带断裂后这种微环境的变化，但很少有研究探索半月板损伤时发生的生物标志物变化。目的：确定与未受伤的对侧膝关节相比，半月板损伤是否会导致滑膜液生物标志物浓度的显著改变。此外，探讨这些患者的滑膜液生物标志物与软骨损伤程度之间的关系。研究设计：横断面研究；证据水平，3。方法：前瞻性纳入2011年10月至2016年12月接受单侧半月板损伤手术的患者，在半月板手术时同时采集损伤膝关节和对侧未损伤膝关节的滑液样本。在切口前收集滑液样本，用多重磁珠免疫分析法测定10种感兴趣的生物标志物的浓度。比较手术和对侧膝关节的滑膜液生物标志物的浓度。此外，将伴有高级别软骨病变的患者与低级别软骨病变患者的手术膝关节滑膜液生物标志物浓度进行比较。结果：目前的分析包括来自41例接受关节镜手术治疗症状性半月板损伤患者的82个膝关节（41个手术和41个对侧）的滑液样本。患者平均+/- SD年龄为49.86 +/- 11.75岁。在控制症状持续时间、体重指数、年龄和患者变异的随机影响时，与无症状膝关节相比，有症状膝关节中5种促炎生物标志物（IL-6、MCP-1、MIP-1 β和MMP-3）中的4种浓度显著更高。在受伤的膝关节中，相关的高级别软骨病变可预测MCP-1、MIP-1 β和VEGF水平升高。滑液中TIMP-1的低浓度或MMP-3与TIMP-1的较大比例与滑膜炎的存在有关。发现年龄增加是症状性半月板损伤时IL-6、MCP-1和VEGF浓度升高的独立预测因子。结论：作者确定了4种促炎滑膜液生物标志物，其浓度在半月板损伤后与未损伤的对侧膝关节相比有显著差异。此外，他们还描述了相关软骨损伤、滑膜炎和患者年龄对生物标志物浓度的影响。
Background: Changes in the joint microenvironment after an injury to the articular surface of the knee have been implicated in the pathogenesis of osteoarthritis. While prior studies focused on changes in this microenvironment after anterior cruciate ligament ruptures, few have explored the biomarker changes that occur in the setting of meniscal injuries. Purpose: To determine whether meniscal injury results in significant alterations to synovial fluid biomarker concentrations as compared with noninjured contralateral knees. Additionally, to explore the relationship between synovial fluid biomarkers and the degree of cartilage injury seen in these patients. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients undergoing surgery for unilateral meniscal injury were prospectively enrolled from October 2011 to December 2016, forming a cohort that had synovial fluid samples collected from both the injured knee and the contralateral uninjured knee at the time of meniscal surgery. Synovial fluid samples were collected just before incision, and the concentrations of 10 biomarkers of interest were determined with a multiplex magnetic bead immunoassay. The concentrations of synovial fluid biomarkers from the operative and contralateral knees were compared. Additionally, the synovial fluid biomarker concentrations of operative knees from patients with associated high-grade cartilage lesions were compared with those with low-grade lesions. Results: The current analysis included synovial fluid samples from 82 knees (41 operative and 41 contralateral) from 41 patients undergoing arthroscopic surgery to treat a symptomatic meniscal injury. The mean +/- SD age of patients was 49.86 +/- 11.75 years. There were significantly greater concentrations of 4 of the 5 proinflammatory biomarkers (IL-6, MCP-1, MIP-1 beta, and MMP-3) in symptomatic knees as compared with asymptomatic knees when controlling for the duration of symptoms, body mass index, age, and the random effects of by-patient variability. In the injured knees, associated high-grade cartilage lesions were predictive of elevated MCP-1, MIP-1 beta, and VEGF levels. Low synovial fluid concentration of TIMP-1 or a greater ratio of MMP-3 to TIMP-1 was associated with the presence of synovitis. Increasing age was found to be an independent predictor of increased IL-6, MCP-1, and VEGF concentrations in the setting of symptomatic meniscal injury. Conclusion: The authors identified 4 proinflammatory synovial fluid biomarkers whose concentrations were significantly different after meniscal injury as compared with uninjured contralateral knees. Furthermore, they describe the effects of associated cartilage damage, synovitis, and patient age on biomarker concentrations.