PHYSIOLOGICAL APPROACH TO ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS
PHYSIOLOGICAL APPROACH TO ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS
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DOI：
10.1172/jci106594
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发表时间：
1971-01-01
影响因子：
15.9
通讯作者：
DECKER, JL
中科院分区：
文献类型：
--
作者：
GOETZL, EJ;FALCHUK, KH;DECKER, JL
描述了一种评估人体膝关节体内耗氧量和乳酸产生率的方法。它基于动脉止血带阻断关节循环后关节内盐水池中血氧饱和度下降的速度和乳酸浓度的上升速度。对5名退行性关节疾病患者和29名类风湿关节炎患者的研究表明，与对照关节相比，患有严重疾病的类风湿关节的平均摄氧率增加了2~3倍，平均乳酸出现率增加了10~12倍。这些代谢变量与滑膜活检中估计的组织代谢需求相关。反映关节循环血流的关节内间隙133Xe洗脱率显示，类风湿关节(48项研究)的平均洗脱率是对照关节(7项研究)的3倍，两组之间存在广泛重叠。133Xe洗脱率与临床和组织学估计的膝关节炎症相关。在4名滑膜切除患者中，有3名患者手术侧膝关节的乳酸产量比对侧膝关节下降得更多。膝关节摄氧量或~(133)Xe洗脱率均无明显变化。关节内注射皮质类固醇(8名患者)导致注射的膝关节乳酸生成减少，133Xe洗脱率降低，而未治疗的膝关节结果不同。治疗后摄氧量再次保持不变。
A method is described for assessing the in vivo oxygen consumption and lactate production rates of human knee joints. It is based on the rate of fall of Po2and the rate of rise in lactate concentration in an intra-articular saline pool after interruption of the circulation to the joint with an arterial tourniquet. Studies in 5 control patients with degenerative joint disease and 29 patients with rheumatoid arthritis showed a 2- to 3-fold higher mean oxygen uptake rate and a 10- to 12-fold higher mean lactate appearance rate in the saline in the rheumatoid joints with severe disease compared to the control joints. These metabolic variables correlated with tissue metabolic demand as estimated in synovial biopsies.133Xe washout from the intra-articular space, which reflects joint circulatory flow, showed a 3-fold greater mean washout rate from the rheumatoid joints (48 studies) than control joints (7 studies) with extensive overlap between the two groups.133Xe washout rate correlated with knee joint inflammation estimated both clinically and histologically. After synovectomy in four patients, the operated knee showed a greater fall in lactate production than the opposite knee in three of these patients. Neither knee joint oxygen uptake nor133Xe washout rate changed significantly. Intra-articular corticosteroid injection (eight patients) resulted in decreased lactate production and a decreased133Xe washout rate in the injected knee and variable results in the untreated knee. Oxygen uptake again was unchanged after therapy.