H-1-NUCLEAR MAGNETIC-RESONANCE STUDIES OF HUMAN SYNOVIAL-FLUID IN ARTHRITIC DISEASE STATES AS AN AID TO CONFIRMING METABOLIC-ACTIVITY IN THE SYNOVIAL CAVITY
H-1-NUCLEAR MAGNETIC-RESONANCE STUDIES OF HUMAN SYNOVIAL-FLUID IN ARTHRITIC DISEASE STATES AS AN AID TO CONFIRMING METABOLIC-ACTIVITY IN THE SYNOVIAL CAVITY
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DOI：
10.1042/cs0850343
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发表时间：
1993-09-01
期刊：
影响因子：
6
通讯作者：
WALSH, E
中科院分区：
文献类型：
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作者：
DUFFY, JM;GRIMSHAW, J;WALSH, E
1.一个H-1-N.方法用于测量在正常检查过程中从参加风湿病和整形外科诊所的患者的膝关节获得的滑液中的缬氨酸、丙氨酸、乳酸盐、乙酸盐、透明质酸和脂质的浓度。16例骨关节炎患者、18例类风湿性关节炎患者、4例尿道撕裂患者和1例系统性红斑狼疮、单关节炎、滑膜炎和游离体患者均获得了液体。取4例正常脑组织标本进行比较.缬氨酸、丙氨酸和乙酸水平均呈正态高斯分布，反映了样本人群血清中的分布.乳酸浓度分为两种不同的模式。浓度低于2.5 mmol/l时，乳酸水平呈高斯分布，反映了正常血清中的分布。正常滑液标本属于这种分布。高于2.5-3.0 mmol/l时，乳酸水平分布不对称，在较高浓度下具有长尾。这些高水平的乳酸可以通过滑膜腔内无氧代谢产生乳酸来解释。这一代谢过程是由一般的炎症条件触发的，如类风湿性关节炎。4. n.m.r.的分布-类风湿性关节炎和骨关节炎中可观察到的脂质浓度均显示正态分布，并且类风湿性关节炎中的平均浓度显著更高。增加的核磁共振-可观察到的透明质酸浓度与炎症情况有关。可以得出结论，乳酸和n.m.r.-可观察到的透明质酸和脂质是有助于临床区分类风湿性关节炎和骨关节炎的有用标记。本研究的结果证实类风湿性关节炎是一种炎症性疾病，在滑膜腔内诱导更高的代谢活动。
1. A H-1-n.m.r. method was used to measure concentrations of valine, alanine, lactate, acetate, hyaluronan and lipids in synovial fluid obtained, during the normal course of examination, from the knee joints of patients attending rheumatology and orthopaedic clinics. Fluid was available from 16 patients with osteoarthritis, 18 patients with rheumatoid arthritis, four patients with meniscal tear and one patient each with systemic lupus erythematosis, mono-arthritis, synovitis and loose bodies. Four normal specimens were obtained for comparison.2. Valine, alanine and acetate levels all showed a normal Gaussian distribution, reflecting the distributions within the serum of the sample population.3. Lactate concentrations divided into two distinct patterns. At concentrations below 2.5 mmol/l the lactate levels showed a Gaussian distribution, reflecting the distribution in normal serum. The normal synovial fluid specimens belong to this distribution. Above 2.5-3.0 mmol/l, lactate levels were asymmetric in distribution with a long tail at higher concentrations. These high levels of lactate can be explained by the generation of lactate through anaerobic metabolism within the synovial cavity. This metabolic process is triggered by a general inflammatory condition such as in rheumatoid arthritis.4. The distribution of n.m.r.-observable lipid concentrations in rheumatoid arthritis and osteoarthritis each shows a normal distribution and the mean concentration is significantly higher in rheumatoid arthritis.5. An increased n.m.r.-observable hyaluronan concentration is associated with an inflammatory situation.6. It is concluded that raised levels of lactate and n.m.r.-observable hyaluronan and lipids are useful markers to aid the clinical distinction between rheumatoid arthritis and osteoarthritis. The results of this study confirm rheumatoid arthritis as an inflammatory disease inducing higher metabolic activity within the synovial cavity.